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Dunford EK, Scully M, Coyle D. Commercially-produced infant and toddler foods-How healthy are they? An evaluation of products sold in Australian supermarkets. MATERNAL & CHILD NUTRITION 2024:e13709. [PMID: 39133124 DOI: 10.1111/mcn.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
In response to the need for better guidance and regulation for commercially produced infant and toddler foods and beverages, the WHO Regional Office for Europe published a Nutrient and Promotion Profile Model (hereafter NPPM) in 2022. This study assessed the nutritional and promotional profile of infant and toddler foods (for ages 6-36 months) sold in Australian supermarkets in 2022 using the NPPM. The main types of claims used for product promotion were also examined and results were presented by category and by packaging type. Nutrient and claims data were extracted for commercially produced infant and toddler products from The George Institute's FoodSwitch database. Products were classified according to NPPM food categories and assessed against relevant nutritional and promotional requirements. Of the 309 products examined, 78% failed to meet the nutritional requirements of the NPPM, and 0% met the promotional requirements. Every product had at least one claim on-pack that was prohibited under the NPPM, with some products displaying up to 21 different claims on-pack. Pouches had the highest number of prohibited claims of all packaging types. Findings highlight that urgent work is needed to improve the nutritional quality of commercially produced infant and toddler foods in Australia. The high use of prohibited claims also suggests the need to regulate the type and number of claims that can be made on-pack, as parents and carers could easily be misled by the deceptive labelling that is currently allowed to be displayed.
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Affiliation(s)
- Elizabeth K Dunford
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Daisy Coyle
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Pries AM, Bassetti E, Badham J, Baker P, Blankenship J, Dunford EK, Kupka R. Ultraprocessing and presence of additives in commercially produced complementary foods in seven Southeast Asian countries: a cross-sectional study. Am J Clin Nutr 2024; 120:310-319. [PMID: 38816268 DOI: 10.1016/j.ajcnut.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND There has been a dramatic shift in food systems, and the consumption of commercially processed and packaged foods has grown globally, including among older infants and young children. Many of these products are ultraprocessed and contain additives, with concerning implications for the health and nutrition of children. OBJECTIVES The study objectives were as follows: 1) to assess the levels of processing among different commercially produced complementary food product (CPCF) categories marketed in the Southeast Asia region, 2) to compare the nutrient content of CPCF products across levels of processing, and 3) to assess the types of additives present in different CPCF categories. METHODS This cross-sectional study involved secondary analysis of a cross-sectional dataset of product label information from CPCF purchased in 2021 in Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Philippines, Thailand, and Viet Nam. Ingredient lists were reviewed to determine the level of processing-based on the Nova classification-and the presence of additives. Nutrient declaration panels were reviewed to determine total sugar, sodium, and total fat. RESULTS Nearly half of all CPCF were ultraprocessed, with total sugar and sodium content significantly higher among ultraprocessed CPCF than unprocessed/minimally processed products. Almost half of CPCF contained additives, with a median of 6 per product. More than 30% of all CPCF made use of cosmetic additives to enhance the products' appearance, flavor, or texture, with emulsifiers, colors, and thickeners the most prevalent. Almost one-third of products contained additives not permitted in Codex Alimentarius standards and guidelines for CPCF. CONCLUSIONS Findings from this study should alert national governments to both adopt and ensure enforcement of Codex guidance on additives and regulations enacted to encourage lower levels of processing for CPCF.
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Affiliation(s)
- Alissa M Pries
- UNICEF East Asia Pacific Regional Office, Bangkok, Thailand.
| | | | | | - Philip Baker
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | - Elizabeth K Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Department of Nutrition, Gillings Global School of Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Roland Kupka
- UNICEF East Asia Pacific Regional Office, Bangkok, Thailand
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3
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Cavalcanti MB, Silva IDCGD, Lamarca F, de Castro IRR. Research on commercial milk formulas for young children: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13675. [PMID: 38956436 DOI: 10.1111/mcn.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
A scoping review of publications about commercial milk formulas intended for or consumed by children 12-36 months (CMF 12-36) was conducted. This review aimed to comprehensively map the existing literature, identify key concepts in the field and understand its evolution through time. A total of 3329 articles were screened and 220 were included, published between 1986 and 2024. Most works were published after 2016 (70.0%) and in high-income countries (71.8%). Original studies were the vast majority (81.8%) of publications. Most publications dealt with feeding practices or analysed the composition and/or contamination of specific products (44.1% and 35.9%), but since the late 2000s, publications about marketing, policy, legislation, and consumer perception started to appear. Most published works (65.5%) did not focus exclusively on CMF 12-36 and included formulas for other demographics or other foods. About half of the works (55.5%) did not consider CMF 12-36 to be a breast milk substitute. We found 81 distinct product denominations used to refer to CMF 12-36, Growing Up Milk was the most common (25.9%). CMF industry was involved in 41.8% of all analysed works, and industry participation and funding were not always clearly informed (22.5% lacked a conflict of interest statement, and 25.5% did not present any information about funding). In the last decade, publications about CMF 12-36 have increased in volume and diversified in scope and subject matter. CMF-industry participation has always been and still is present in the field, so possible vested interests should be taken into account when appreciating the literature.
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Affiliation(s)
| | | | - Fernando Lamarca
- Department of Applied Nutrition, Institute of Nutrition, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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TatahMentan M, Nyachoti S, Godebo TR. Elemental composition of toxic and essential elements in rice-based baby foods from the United States and other countries: A probabilistic risk analysis. Food Chem Toxicol 2024; 188:114677. [PMID: 38641042 DOI: 10.1016/j.fct.2024.114677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Consumption of rice-based foods provides essential nutrients required for infants and toddlers' growth. However, they could contain toxic and excess essential elements that may affect human health. The study aims to determine the composition of rice-based baby foods in the USA and outside and conduct a multiple-life stages probabilistic exposure and risk assessment of toxic and essential elements in children. Elemental concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in thirty-three rice-based baby foods. This includes 2 infant formulas, 11 rice baby cereals, and 20 rice snacks produced primarily in the United States, China, and other countries. A probabilistic risk assessment was conducted to assess risks of adverse health effects. Results showed that infant formula had higher median concentrations of selenium (Se), copper (Cu), zinc (Zn), sodium (Na), magnesium (Mg), calcium (Ca), and potassium (K) compared to rice baby cereal and rice snacks. On the contrary, rice snacks had the highest median concentration of Arsenic (As) (127 μg/kg) while rice baby cereals showed the highest median concentration of Cd (7 μg/kg). A higher lifetime estimated daily intake was observed for samples manufactured in the USA compared to those from China and other countries. Hazard quotient (HQ < 1) values were suggestive of minimal adverse health effects. However, lifetime carcinogenic risk analysis based on total As indicated an unacceptable cancer risk (>1E-04). These findings show a need for ongoing monitoring of rice-based foods consumed by infants and toddlers as supplementary and substitutes for breast milk or weaning food options. This can be useful in risk reduction and mitigation of early life exposure to improve health outcomes.
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Affiliation(s)
- Mom TatahMentan
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Syprose Nyachoti
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Tewodros Rango Godebo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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Scully M, Jinnette R, Le L, Martin J, Schmidtke A. Compliance of Australian commercial foods for young children (<36 months) with an international nutrient and promotion profile model. Aust N Z J Public Health 2024; 48:100158. [PMID: 38886145 DOI: 10.1016/j.anzjph.2024.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To assess how Australian infant and toddler foods compare to a nutrient and promotion profile model (NPPM) developed by the World Health Organization to support the appropriate promotion of commercial food products for children aged 6-36 months. METHODS A cross-sectional audit of infant and toddler foods found at three major Australian supermarkets was conducted in September/October 2022. Using nutrition and promotional data extracted from the packaging, products were classified according to NPPM categories and assessed against relevant compositional, front-of-pack labelling and promotional requirements. RESULTS Of 330 eligible products identified, just 28% met all NPPM compositional requirements. Toddler foods were less compliant than infant foods overall (18% vs. 31%; p=0.021), and for specific nutrients such as sodium (75% vs. 89%; p=0.003). No products met all NPPM front-of-pack labelling/promotional requirements. Only two-thirds and two-fifths of products were compliant with product name and ingredient list requirements, respectively. CONCLUSION Australian infant and toddler foods do not fully comply with the NPPM requirements. While toddler foods performed comparatively worse in terms of their nutritional adequacy, there is considerable scope to improve the nutrient profile of both infant and toddler foods. IMPLICATIONS FOR PUBLIC HEALTH To better support young children's health and development, the introduction of mandatory nutrition standards for Australian toddler foods, and the improvement of nutrition standards for Australian infant foods, in line with the NPPM, is needed. To be most effective, these should be combined with regulations for the labelling and promotion of these foods in line with the NPPM.
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Affiliation(s)
- Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Rachael Jinnette
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Linh Le
- Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jane Martin
- Food for Health Alliance, Melbourne, Victoria, Australia
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Dixon HG, Awoke MA, Scully M, McCann J, Martin J, Morley B, Rhodes A, McAleese A, Schmidtke A. Effects of marketing claims on toddler food products on parents' product preferences, perceptions and purchasing intentions: an online experiment. Int J Behav Nutr Phys Act 2024; 21:60. [PMID: 38773586 PMCID: PMC11110258 DOI: 10.1186/s12966-024-01603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/28/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents' responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. METHODS Parents of toddlers aged 12 to < 36 months (N = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains "good" ingredient'; 'free from "bad" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. RESULTS For the overall sample, brief exposure to 'free from "bad" ingredient' claims increased participant's intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that 'contains "good" ingredient' claims and 'child-related' claims significantly impacted parent's preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed 'contains "good" ingredient' or 'free from "bad" ingredient' claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. CONCLUSIONS Findings indicate that 'free from "bad" ingredient' claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. 'Contains "good" ingredient' claims and 'child-related' claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children's diets and health.
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Affiliation(s)
- Helen Gwenda Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 200 Victoria Pde., East Melbourne, VIC, 3002, Australia.
- School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Mamaru Ayenew Awoke
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 200 Victoria Pde., East Melbourne, VIC, 3002, Australia
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 200 Victoria Pde., East Melbourne, VIC, 3002, Australia
| | - Jennifer McCann
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Jane Martin
- Food for Health Alliance, Melbourne, VIC, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 200 Victoria Pde., East Melbourne, VIC, 3002, Australia
| | - Anthea Rhodes
- The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Alison McAleese
- Prevention Division, Cancer Council Victoria, Melbourne, VIC, Australia
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7
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Kelly M, McCann JR, Chapple CI, Woods J, Russell CG. Visual communication design: a neglected factor in nutrition promotion via packaged food labels. Front Public Health 2024; 12:1296704. [PMID: 38420036 PMCID: PMC10899386 DOI: 10.3389/fpubh.2024.1296704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.
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Affiliation(s)
- Meghan Kelly
- School of Communication and Creative Arts, Faculty of Arts and Education, Deakin University, Geelong, VIC, Australia
| | - Jennifer R. McCann
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Celeste I. Chapple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Julie Woods
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Catherine G. Russell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Richter APC, Grummon AH, Falbe J, Taillie LS, Wallace DD, Lazard AJ, Golden SD, Conklin JL, Hall MG. Toddler milk: a scoping review of research on consumption, perceptions, and marketing practices. Nutr Rev 2024; 82:425-436. [PMID: 37203416 PMCID: PMC10859688 DOI: 10.1093/nutrit/nuad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Toddler milk is an ultra-processed beverage consisting primarily of powdered milk, caloric sweeteners, and vegetable oil. Pediatric health authorities do not support the use of toddler milk, and emerging evidence suggests that toddler-milk marketing practices may mislead consumers. However, studies have not synthesized the extent of toddler-milk marketing practices or how these practices affect parents' decisions about whether to serve toddler milk. We aimed to summarize the literature about toddler milk to identify what is known about: (1) parents' toddler-milk purchasing and feeding behaviors, (2) toddler-milk marketing, and (3) how marketing practices influence parents' beliefs and perceptions about toddler milk. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we systematically searched 8 databases (PubMed, APA PsycINFO, Scopus, Cochrane Central, Embase, CINAHL, Communication & Mass Media Complete, and Business Source Premier). We identified 45 articles about toddler milk. Studies were conducted in 25 countries across 6 continents. Five types of findings emerged: (1) consumption and feeding behaviors, (2) demographic correlates of toddler-milk purchasing and consumption, (3) misperceptions and beliefs, (4) increased sales, and (5) increased marketing and responses to marketing. The included articles suggested that toddler-milk sales are growing rapidly worldwide. Findings also revealed that toddler-milk packages (eg, labels, branding) resemble infant formula packages and that toddler-milk marketing practices may indirectly advertise infant formula. Purchasing, serving, and consumption of toddler milk were higher in Black and Hispanic populations than in non-Hispanic White populations, and parents with higher educational attainment and income were more likely to offer toddler milk to their children. Findings suggest a need for policies to prevent cross-marketing of toddler milk and infant formula, reduce provision of toddler milk to infants and toddlers, and prevent caregivers from being misled about toddler-milk healthfulness.
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Affiliation(s)
- Ana Paula C Richter
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna H Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer Falbe
- Department of Human Ecology, University of California (UC) Davis, Davis, California, USA
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deshira D Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Iyer A, Kent K, Brunacci K, Agho KE, Fleming CAK. Feeding Practices, Parent Perceptions, and Diet Diversity in a Sample of Children Aged 0-5 Years from Western Sydney, Australia: A Mixed Methods Study. Nutrients 2024; 16:198. [PMID: 38257091 PMCID: PMC10821087 DOI: 10.3390/nu16020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Sub-optimal feeding practices and dietary intakes in childhood are associated with poor health outcomes in adulthood. This mixed methods study aims to profile feeding practices, parent perceptions, and dietary diversity in a sample of children aged 0-5 years (n = 29) from Western Sydney, Australia. (2) Methods: In 2019, semi-structured interviews were conducted with parents, exploring their child's feeding practices. An online quantitative survey was used to assess children's feeding history. Nutrient intakes and dietary diversity scores were assessed using an online 24-h dietary recall. Quantitative data were analysed using descriptive statistics and one-way ANOVA, while qualitative data were analysed using inductive thematic analysis. (3) Results: The analysis showed that 27.6% of children were exclusively breastfed until 6 months of age and that 62.1% of children were introduced to solids before 6 months. Over 60% of children achieved minimum dietary diversity. The thematic analysis identified four themes, including mothers' feeding choices, mothers' perceptions of their children's diet, influences on feeding choices, and mothers' personal experiences. (4) Conclusions: The feeding history of over half the children in this sample indicated non-compliance with Australian and WHO infant feeding guidelines. The thematic analysis revealed various possible influences on parent feeding choices that can be used to inform targeted support.
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Affiliation(s)
- Anjana Iyer
- School of Science, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Katherine Kent
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kaitlyn Brunacci
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
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10
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McCann JR, Woods J, Russell CG. Australian Stakeholder Perspectives on Healthier Retail Food Environments for Toddlers-The Era of "Band Aids and Small Inroads". Curr Dev Nutr 2024; 8:102060. [PMID: 38269109 PMCID: PMC10806265 DOI: 10.1016/j.cdnut.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024] Open
Abstract
Background A healthy diet in young children is crucial for optimal growth and development. However, many toddlers (1-3 y) consume suboptimal diets, and as a result, are at a high risk of experiencing negative health outcomes. Moreover, minimal progress has been made to improve the healthiness of retail food environments for toddlers to date despite the potential and advocacy for the issue. Objectives To gain insight into stakeholder perceptions and opinions on the healthiness of Australian retail food environments for toddlers, as well as perspectives on the options and barriers to improve their healthiness. Methods Qualitative, online study utilizing semi-structured individual interviews with 27 key stakeholders from food industry, academia, nongovernment organizations, public health, and government in Australia. Results Most stakeholders agreed that retail food environments for toddlers were not health promoting. Stakeholders identified that a multifaceted approach including nutrition education and strong government mandated regulation were essential to improve the healthiness of retail food environments for toddlers. Interviews also highlighted the main perceived barriers to progress, and reasons for policy inaction in this area are the food industry and government support. Many stakeholders were concerned that child health is being undermined due to the government favoring business needs over public health. Conclusions Stakeholders in this study overwhelmingly agreed that there is more that can and should be done to create health promoting retail food environments for toddlers in Australia. Stakeholders identified a range of strategies that can be used to improve the healthiness of toddler food environments, but advocacy efforts are being undermined due to government inaction. Stakeholders believed that strong governance is required to create equitable, sustainable healthy retail food environments for young children. Improving the healthiness of retail food environments for young children will not only reduce diet related disease across the lifespan but will help to address financial and societal costs of a poor diet.
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Affiliation(s)
- Jennifer R McCann
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences
| | - Julie Woods
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences
| | - Catherine G Russell
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences
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11
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Chung A, Myers J, Skouteris H, Backholer K. Front-of-pack marketing on infant and toddler foods: Targeting children and their caregivers. Aust N Z J Public Health 2023; 47:100101. [PMID: 38030442 DOI: 10.1016/j.anzjph.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To identify and quantify child- and caregiver-appeal on front-of-pack marketing on infant and toddler foods in the Australian food supply. METHODS Content analysis of the presence and type of front-of-pack marketing techniques displayed on the front-of-pack of infant and toddler foods (for children aged up to 36 months) available in Australia's two major supermarkets' online stores. RESULTS Infant and toddler foods are promoted by up to 15 unique marketing techniques on the front-of-pack with an average of eight unique features per pack. A majority of food packages included marketing techniques targeting children, and all food packages included marketing techniques targeting caregivers, most commonly promoting health and nutrition. CONCLUSIONS Infant and toddler food packages are saturated with front-of-pack marketing features that target children and caregivers. To adequately protect young children's diets from the harmful influence of food marketing, and to promote the development of optimal feeding behaviours, government-led controls of all marketing intended to influence children's diets are required. In the context of marketing infant and toddler foods, this includes regulation of front-of-pack marketing techniques targeted to children and their caregivers. IMPLICATIONS FOR PUBLIC HEALTH Comprehensive government-led food marketing controls are required to protect children's diets from the harmful influence of marketing. The scope of these controls must include all unhealthy food marketing that children are exposed to and all other forms of unhealthy food marketing intended to influence children's diets.
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Affiliation(s)
- Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Judith Myers
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Kathryn Backholer
- Global Centre for Physical Activity and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
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12
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Pries AM, Bassetti E, White JM, Mulder A, Threapleton D, Blankenship J. Benchmarking the nutrient composition and labelling practices of finger foods and snacks for older infants and young children across seven Southeast Asian countries. MATERNAL & CHILD NUTRITION 2023; 19 Suppl 2:e13598. [PMID: 38092380 PMCID: PMC10719055 DOI: 10.1111/mcn.13598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023]
Abstract
Ensuring consumption of nutrient-dense, safe and appropriate complementary foods among older infants and young children (IYC) 6-36 months of age is critical for enabling optimal growth and development. The ubiquitous availability of and high demand for commercially packaged snack foods has culminated in a growing trend of snack food products specifically produced and promoted for older IYC. Commercially produced complementary foods (CPCF) that are finger foods/snacks often contain added sugars, excessive sodium content and high total sugar content, making them inappropriate for this young population. This study benchmarked the nutrient composition and labelling practices of CPCF finger foods/snacks available for purchase in seven countries in Southeast Asia. The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older IYC. Of the total 606 products identified, 8.2% were automatically categorized as not suitable because they were confectionery items. Of the remaining 556 products assessed, over 85% failed to meet all nutrient composition requirements, with the presence of added sugars/sweeteners and excessive sodium and total sugar contents the primary reasons for failure. Products also demonstrated concerning labelling practices, with all of the products (98.6%) displaying an inappropriate claim on the label. These findings reveal major concerns with the nutrient composition and labelling practices of CPCF finger foods/snacks in the SEA region and should serve as an alarm bell for regulatory action. National binding legal measures, such as mandatory standards for composition and labelling are urgently needed.
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Hernández-Cordero S, Vilar-Compte M, Tomori C, Lara-Mejía V, Rovelo-Velázquez N, Hayes K, Pérez-Escamilla R. Healthcare professionals and commercial milk formula recommendations in the urban Mexican context. Front Public Health 2023; 11:1260222. [PMID: 38045970 PMCID: PMC10693414 DOI: 10.3389/fpubh.2023.1260222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions. Methods The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs. Results Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF. Discussion This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.
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Affiliation(s)
- Sonia Hernández-Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Cecília Tomori
- Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Vania Lara-Mejía
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Natalia Rovelo-Velázquez
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
| | - Keily Hayes
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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14
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Sugimoto M, Yuan X, Uechi K, Sasaki S. The nutritional profile of commercial complementary foods in Japan: comparison between low- and high-price products. Br J Nutr 2023; 130:1595-1608. [PMID: 36912086 PMCID: PMC10564588 DOI: 10.1017/s0007114523000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
Despite the increasing market share of commercial complementary foods, their nutritional characteristics and those associated with the price of products are still unknown in Japan. We compared the nutritional characteristics of commercially available complementary foods of different price levels in Japan. Data were obtained from the websites of Japanese brands of infant and young children's food. Nutrient profiles (unit/100 g), ingredients and food additives were compared between low- and high-priced products by product type. Sixty-three dry meals, 425 soft meals, 187 snacks and sweets, and 60 drinks were analysed. One-fifth of meals and snacks exceeded the CODEX-defined limit (200 mg Na/100 g). Most products lacked content information on nutrients non-mandated to be indicated. High-priced soft meals contained more protein (2·5 v. 1·9 g/100 g) and less Na (0·18 v. 0·46 g/100 g), less frequently used ≥ 1 added sugar (23 % v. 82 %), and less frequently used food additives than low-priced products; however, they had a lower variety of ingredients. The prevalence of products containing ≥ 1 added sugar was higher in low-priced snacks and sweets (91 % v. 77 %) but lower in drinks (48 % v. 84 %) than in their high-priced counterparts. High Na content is a concern among commercial complementary foods in Japan. Nonetheless, the relationship between the price and nutritional profile of these foods differs by product type. High-priced soft meals might be more favourable regarding nutrient content but not the variety of ingredients than low-priced counterparts. These findings elucidate the nutritional characteristics of commercial complementary foods in Japan.
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Affiliation(s)
- Minami Sugimoto
- Institute for Future Initiatives, University of Tokyo, Tokyo113-0033, Japan
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo143-8540, Japan
| | - Xiaoyi Yuan
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo162-8636, Japan
| | - Ken Uechi
- Division of Community Health Nursing, Faculty of Health Science, Toho University, 2-2-1 Miyama, Chiba274-8510, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo113-0033, Japan
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15
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Scully M, Schmidtke A, Conquest L, Martin J, McAleese A. Commercially available foods for young children (<36 months) in Australia: An assessment of how they compare to a proposed nutrient profile model. Health Promot J Austr 2023; 34:750-758. [PMID: 36786727 DOI: 10.1002/hpja.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
ISSUE ADDRESSED To assess the nutritional composition of commercially available foods (CAFs) for infants and toddlers sold in Australia to determine whether they meet World Health Organization (WHO) Europe's proposed standards for nutritionally appropriate foods for children <36 months. METHODS A cross-sectional retail audit of infant (n = 177) and toddler (n = 73) foods found in-store and online at three major Victorian supermarkets was conducted in August/September 2019. Products were grouped according to WHO Europe's food categories and their nutrient content assessed against specific composition standards applicable to their category. The presence of added sugar in each product was also recorded. RESULTS Most infant products (71%) were soft-wet spoon-able, ready-to-eat foods whereas the most prevalent category for toddler products was dry finger foods and snacks (71%). Overall, just one-third of CAFs met all the nutrient recommendations for their category, with infant foods more likely to be compliant than toddler foods (43% vs. 10%; P < .001). Around 9 in 10 infant (93%) and toddler (89%) CAFs contained added sugar according to the Public Health England definition of 'free' sugars. CONCLUSIONS There is considerable scope to improve the nutritional composition of Australian CAFs for both infants and toddlers, to reduce harmful sugars in these foods and to improve the energy density of them. For CAFs marketed as suitable for toddlers there is also considerable scope to reduce the sodium content. SO WHAT?: These findings support the need for stronger regulation of CAFs for infants and toddlers to better promote healthy eating patterns and taste preferences in young children.
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Affiliation(s)
- Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
| | | | - Libby Conquest
- Prevention Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Jane Martin
- Obesity Policy Coalition, Melbourne, VIC, Australia
| | - Alison McAleese
- Prevention Division, Cancer Council Victoria, Melbourne, VIC, Australia
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16
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Bakshi S, Paswan VK, Yadav SP, Bhinchhar BK, Kharkwal S, Rose H, Kanetkar P, Kumar V, Al-Zamani ZAS, Bunkar DS. A comprehensive review on infant formula: nutritional and functional constituents, recent trends in processing and its impact on infants' gut microbiota. Front Nutr 2023; 10:1194679. [PMID: 37415910 PMCID: PMC10320619 DOI: 10.3389/fnut.2023.1194679] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Human milk is considered the most valuable form of nutrition for infants for their growth, development and function. So far, there are still some cases where feeding human milk is not feasible. As a result, the market for infant formula is widely increasing, and formula feeding become an alternative or substitute for breastfeeding. The nutritional value of the formula can be improved by adding functional bioactive compounds like probiotics, prebiotics, human milk oligosaccharides, vitamins, minerals, taurine, inositol, osteopontin, lactoferrin, gangliosides, carnitine etc. For processing of infant formula, diverse thermal and non-thermal technologies have been employed. Infant formula can be either in powdered form, which requires reconstitution with water or in ready-to-feed liquid form, among which powder form is readily available, shelf-stable and vastly marketed. Infants' gut microbiota is a complex ecosystem and the nutrient composition of infant formula is recognized to have a lasting effect on it. Likewise, the gut microbiota establishment closely parallels with host immune development and growth. Therefore, it must be contemplated as an important factor for consideration while developing formulas. In this review, we have focused on the formulation and manufacturing of safe and nutritious infant formula equivalent to human milk or aligning with the infant's needs and its ultimate impact on infants' gut microbiota.
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Affiliation(s)
- Shiva Bakshi
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
| | - Vinod Kumar Paswan
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
| | - Satya Prakash Yadav
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
| | - Basant Kumar Bhinchhar
- Department of Livestock Production Management, Sri Karan Narendra Agriculture University, Jobner, India
| | - Sheela Kharkwal
- Department of Agriculture Economics, Sri Karan Narendra Agriculture University, Jobner, India
| | - Hency Rose
- Division of Dairy Technology, ICAR—National Dairy Research Institute, Karnal, India
| | - Prajasattak Kanetkar
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
| | - Vishal Kumar
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
| | - Zakarya Ali Saleh Al-Zamani
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
- Department of Food Technology and Science, Faculty of Agriculture and Veterinary Medicine, Ibb University, Ibb, Yemen
| | - Durga Shankar Bunkar
- Department of Dairy Science and Food Technology, Institute of Agricultural Sciences, Banaras Hindu University, Varanasi, India
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Brunacci KA, Salmon L, McCann J, Gribble K, Fleming CAK. The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia. BMC Public Health 2023; 23:656. [PMID: 37024884 PMCID: PMC10077707 DOI: 10.1186/s12889-023-15492-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. METHODS Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims. RESULTS 276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of 'no added sugar' were made for 59% of pouches, despite the addition of free sugars. CONCLUSIONS Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0-36 months and better inform parents.
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Affiliation(s)
- Kaitlyn A Brunacci
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - Libby Salmon
- School of Regulation and Global Governance, The Australian National University, Canberra, Australia
| | | | - Karleen Gribble
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Catharine A K Fleming
- School of Health Sciences, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Western Sydney University, Sydney, Australia
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18
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Chapple CI, Russell CG, Burnett AJ, Woods JL. Sports foods are not all they shake up to be. An audit of formulated supplementary sports food products and packaging in Australian retail environments. Front Nutr 2023; 10:1042049. [PMID: 36866048 PMCID: PMC9972582 DOI: 10.3389/fnut.2023.1042049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To determine store availability, total number of products, and types of Formulated Supplementary Sports Foods in Australia, along with their stated nutrition content, sweeteners added, total number, and type of claims displayed on the packaging. Design A cross-sectional, visual product audit of mainstream retailers. Setting Supermarkets, pharmacies, health food stores, and gym/fitness centres. Results A total of 558 products were captured in the audit, 275 of which displayed the correct mandatory packaging attributes. Three categories of products were identified, based on the dominant nutrient. Only 184 products appeared to display the correct energy value based on the listed macronutrient content (protein, fat, carbohydrate, dietary fibre). The stated nutrient content was highly variable across all product subcategories. Nineteen different sweeteners were identified, with most foods containing only one (38.2%) or two (34.9%) types. The predominant sweetener was stevia glycosides. Packages displayed multiple claims, with a maximum of 67 and minimum of 2 claims. Nutrition content claims were most frequently displayed (on 98.5% of products). Claims included regulated, minimally regulated and marketing statements. Conclusion Sports food consumers should be provided with accurate and detailed on pack nutrition information, to ensure informed choices are made. However, this audit showed multiple products which did not conform to current standards, appeared to provide inaccurate nutrition information, contained multiple sweeteners, and displayed an overwhelming number of on-pack claims. The increase in sales, availability, and products available in mainstream retail environments, could be impacting both intended consumers (athletes), and general non-athlete population. The results indicate underperformance in manufacturing practices which preference marketing over quality and stronger regulatory approaches are needed to protect consumer health and safety, and to prevent misleading consumers.
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Affiliation(s)
| | - Catherine G. Russell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Alissa J. Burnett
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Julie L. Woods
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Boatwright M, Lawrence M, Russell C, Russ K, McCoy D, Baker P. The Politics of Regulating Foods for Infants and Young Children: A Case Study on the Framing and Contestation of Codex Standard-Setting Processes on Breast-Milk Substitutes. Int J Health Policy Manag 2022; 11:2422-2439. [PMID: 34973054 PMCID: PMC9818087 DOI: 10.34172/ijhpm.2021.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Breastfeeding is important for the health and development of the child, and for maternal health, in all country contexts. However, global sales of breast-milk substitutes (BMS), including infant, follow-up and toddler formulas, have 'boomed' in recent decades. This raises the importance of international food standards established by the Codex Alimentarius Commission (Codex) on the safety, composition and labelling of BMS. Such standards appear to be strongly contested by governments, industry and civil society groups, yet few studies have investigated the politics of Codex standard-setting processes. The aim of this paper is to understand who participates in decision-making, and how actors frame and contest proposals to revise the Codex Standard on Follow-up Formula (FUF). METHODS We adopted a case study design involving two steps. First, we enumerated government, industry, civil society, and international organization stakeholders participating in standard-setting processes of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU). Second, we conducted a framing analysis of stakeholder inputs during the FUF standard revision in CCNFSDU meetings. Publicly available online meeting reports (2015-2019) were retrieved, analyzed using a theoretical framework, and organized thematically. RESULTS High-income country (HIC) delegates greatly outnumbered those from other country income categories. Industry representation was higher compared with other observer categories. Member state delegations included more industry representation than civil society representation, and were occasionally the only member state delegates. Industry stakeholders framed arguments in terms of trade implications, science, and flexible standards. Civil society groups used public health, science, and pro-breastfeeding frames. CONCLUSION Codex BMS standard-setting procedures are dominated by HICs and industry groups. Limited representation of civil society, and of low- and middle-income countries (LMICs), suggest actions are needed to substantially increase support for their involvement at Codex. Such representation may help to counteract power asymmetries and commercial influences on food standards for infants and young children.
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Affiliation(s)
- Monique Boatwright
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - David McCoy
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition, Deakin University, Geelong, VIC, Australia
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Zahra L, Kremer P, Bolton KA. A cross-sectional study of infant feeding practices in Vietnamese-born mothers living in Australia. BMC Pregnancy Childbirth 2022; 22:895. [PMID: 36463117 PMCID: PMC9719657 DOI: 10.1186/s12884-022-05223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Infant feeding practices are a key modifiable risk factor for childhood overweight and obesity; and important for lifelong health and wellbeing. Despite the growing Australian immigrant population, it is unclear how infant feeding practices may differ between ethnicities living in Australia. Few studies have examined the infant feeding practices of Vietnamese mothers who migrate and give birth to infants in Australia - termed Vietnamese-born mothers. The aim of this study was to examine differences in infant feeding practices (breastfeeding, formula feeding and complementary feeding (other fluids and solids)) in Vietnamese-born mothers compared with Australian-born mothers living in Australia. METHOD This study analysed the Australian National Infant Feeding Survey dataset (2010-11), a large national cross-sectional survey measuring feeding practices of infants aged 0-24 months old. Infant feeding practices of Vietnamese-born mothers (n = 261) and a random sub-sample of Australian-born mothers (n = 261) were compared. Associations between ethnicity and infant feeding practices were examined through logistic and linear regression adjusting for maternal age, socioeconomic status, body mass index (BMI) at start of pregnancy, infant age at survey completion and parity. Compliance with the Australian national infant feeding guidelines was also assessed. RESULTS Compliance with infant feeding guidelines was low, with differences in infant feeding practices between groups. At the time of survey completion, when infants were on average 7.2 months old, compared with infants of Australian-born mothers, infants to Vietnamese-born mothers were significantly younger when first exposed to fruit juice (b = -2.41, 95%CI: -4.54- -0.28); less likely to be exposed to solids (AOR: 0.15, 95%CI: 0.05-0.44) and more likely to be exposed to formula milks (AOR: 2.21, 95%CI: 1.10-4.43); toddler milks (AOR: 16.72, 95%CI: 3.11-90.09) and fruit juice (AOR: 2.37, 95%CI: 1.06-5.32) (p < 0.05). CONCLUSION Low adherence with breastfeeding (low breastfeeding and high infant formula use) and other fluids (toddler milks and fruit juice) recommendations outlined by the Australian infant feeding guidelines were observed in this group of Vietnamese-born mothers. To optimise feeding and growth in Vietnamese-Australian children, culturally appropriate infant feeding support targeting breastfeeding durations, reducing reliance on infant formula, and reducing inappropriate introduction to other fluids should be the focus of infant feeding promotion within these mothers.
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Affiliation(s)
- Lauren Zahra
- grid.1021.20000 0001 0526 7079School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC Australia
| | - Peter Kremer
- grid.1021.20000 0001 0526 7079Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Kristy A. Bolton
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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21
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Garcia AL, Menon R, Parrett A. Extensive use of on-pack promotional claims on commercial baby foods in the UK. Arch Dis Child 2022; 107:606-611. [PMID: 35228205 DOI: 10.1136/archdischild-2021-322851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore and categorise the nature of promotional claims on packaging of commercial baby foods (CBFs). SETTING UK METHODOLOGY: An online survey of CBFs (for infants up to 12+ months) in 7 UK supermarkets and Amazon in 2020. On-pack promotions were classified as marketing, composition, health, and nutrient claims using the WHO Nutrient Profile Model draft for infants and young children, and European Union regulation on health and nutrition claims. MAIN OUTCOME MEASURE Distribution and proportion of claim types, and association between product characteristics and claim types. RESULTS A total of 6265 promotional claims were identified on 724 products. Marketing (99%, n=720), composition (97%, n=705) and nutrient claims (85%, n=616) were found on the majority of CBFs, compared with health claims (6%, n=41). The median (Q1, Q3) number of total claims per product was 9 (7, 10), marketing 5 (3, 6), composition 2 (1, 2), nutrient 2 (1, 2), and 0 (0, 0) health. Marketing claims were mainly texture (84%, n=609, eg, super smooth) and taste related (70%, n=511, eg, first tastes). The main composition claim was organic (63%, n=457) while nutrient claims were mainly around 'no added' or 'less' sugar (58%, n=422) and salt (57%, n=417). Baby led weaning claims (BLW) (eg, encourages self-feeding) were found on 72% of snacks, with a significantly higher (p<0.01) number of BLW claims on snacks (99%, n=209) compared with other product types. CONCLUSION Promotional claims on CBF packaging are extensively used and, for the most part, unregulated. CBFs are promoted using 'healthy halo' connotations that might confuse parents. Regulations on their use should be implemented to avoid inappropriate marketing.
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Affiliation(s)
- Ada Lizbeth Garcia
- Human Nutrition, School of Medicine Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rebekah Menon
- Human Nutrition, School of Medicine Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alison Parrett
- Human Nutrition, School of Medicine Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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22
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Commercial Baby Foods Aimed at Children up to 36 Months: Are They a Matter of Concern? Foods 2022; 11:foods11101424. [PMID: 35626994 PMCID: PMC9140705 DOI: 10.3390/foods11101424] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Proper nutrition in infancy and early childhood is crucial to ensuring optimal child development, growth, and better health outcomes later in life. The nutrient profile model proposed by WHO/Europe aims to assess the nutritional quality and promotional/marketing aspects of commercial baby foods aimed at children up to 36 months. We used commercial data from 191 baby foods collected between March 2021 and July 2021, from eight supermarket chains in the Lisbon Metropolitan area. According to the model specifications and the NOVA classification system, we assessed the nutritional quality and promotion aspects and the degree of processing, respectively. The presence of at least one sugar-contributing ingredient was found in 34.0% of the products; 13.9% of products listed sugars and 15.0% listed fruit juices or concentrates as an ingredient. The claim “No added sugar” was present in 69.6% of products. Only 35.1% of products comply with all the nutritional requirements of the model. Concerning processing classification, 61.8% of products were ultra-processed, and about 57.0% were indicated for children < 12 months. These findings reinforce the importance of implementing measures to ensure that commercial foods for infants are marketed appropriately and to promote foods with a lower degree of processing.
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McCann J, Woods J, Mohebbi M, Russell CG. Regulated nutrition claims increase perceived healthiness of an ultra-processed, discretionary toddler snack food and ultra-processed toddler milks: A discrete choice experiment. Appetite 2022; 174:106044. [DOI: 10.1016/j.appet.2022.106044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/14/2022]
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McCann J, Beckford K, Beswick H, Chisholm M, Woods J. Toddler foods and milks don't stack up against regular foods and milks. Nutr J 2022; 21:12. [PMID: 35209925 PMCID: PMC8876127 DOI: 10.1186/s12937-022-00765-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/08/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To compare the cost and nutritional profiles of toddler-specific foods and milks to 'regular' foods and milks. METHODS Cross-sectional audit of non-toddler specific ('regular') foods and milks and secondary analysis of existing audit data of toddler specific (12-36 months) foods and milks in Australia. MAIN FINDINGS The cost of all toddler-specific foods and milks was higher than the regular non-toddler foods. Foods varied in nutritional content, but toddler foods were mostly of poorer nutritional profile than regular foods. Fresh milk cost, on average, $0.22 less per 100 mL than toddler milk. Toddler milks had higher mean sugar and carbohydrate levels and lower mean protein, fat, saturated fat, sodium and calcium levels per 100 mL, when compared to fresh full fat cow's milk. CONCLUSIONS Toddler specific foods and milks cost more and do not represent value for money or good nutrition for young children.
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Affiliation(s)
- Jennifer McCann
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | | | - Julie Woods
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
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What Works to Improve Nutrition and Food Sustainability across the First 2000 Days of Life: A Rapid Review. Nutrients 2022; 14:nu14040731. [PMID: 35215381 PMCID: PMC8878998 DOI: 10.3390/nu14040731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Informed by the Innocenti framework, this rapid review of systematic reviews (n = 60) and sentinel grey literature (n = 27) synthesises the evidence of what works to improve nutrition and food sustainability across the first 2000 days. Most systematic reviews focused on interventions targeting the behaviour of parents and caregivers (n = 49), with fewer reviews focusing on the personal (n = 7) and external (n = 4) food environments. No reviews focused on food supply-chain activities. Most reviews were rated as critically low (n = 28, 47%) or low (n = 21, 35%) quality using AMSTAR 2. Evidence supports the effectiveness of multi-component breastfeeding interventions, interventions delivered in home and child-care settings, particularly when involving parents, interactive skill building and repeated exposure to vegetables. Food vouchers and access to local farmers markets and community gardens have potential for improving access and availability to healthier foods, while evidence supports interventions improving the external food environment, including fiscal strategies such as the SSB tax, restrictions on marketing and advertising of discretionary products and improved food labelling. Overall, this review highlights the importance of action across a range of settings and sectors at the international, national and local levels to improve young children’s diets.
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The Nutritional Profile and On-Pack Marketing of Toddler-Specific Food Products Launched in Australia between 1996 and 2020. Nutrients 2021; 14:nu14010163. [PMID: 35011037 PMCID: PMC8747045 DOI: 10.3390/nu14010163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023] Open
Abstract
With the food system evolving, it is not clear how the nutrition and on-pack claims of toddler foods have been impacted. Data on the trends in Australia are lacking, so we sought to determine the changes in the nutrition and on-pack claims of toddler-specific packaged foods over time. A retrospective cross-sectional analysis was conducted using the Mintel Global New Products Database. The number of toddler-specific foods increased from 1996 to 2020. Over time, a lower proportion of meals and snacks were classified as “ultra-processed”, but a higher proportion of snacks were classified as “discretionary”. Meals launched after 2014 had higher median values for energy, saturated fat, and sugar than those in earlier years. Toddler snacks launched after 2014 had lower median values for sodium, and higher median values for fat, saturated fat, and sugar than those in earlier years. The mean number of total claims per package increased over time for snacks, with an increase in unregulated claims for both meals and snacks. Public health action is needed to ensure that the retail food environment for young children is health-promoting, including stringent and clear regulations for on-pack claims, and compositional guidelines and guidance on how to reduce the number of ultra-processed foods for toddlers.
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Simmonds L, Brownbill AL, Zee A, Netting MJ. Health-related marketing messages on product labels of commercial infant and toddler food packaging in Australia: a cross-sectional audit. BMJ Paediatr Open 2021. [PMCID: PMC8672004 DOI: 10.1136/bmjpo-2021-001241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundProper nutrition in early childhood is essential to ensure optimal growth and development. Use of ‘better-for-you’ features on food packaging position products as healthier for children. This study aims to systematically explore the use of better-for-you labelling on infant and toddler food packaging.MethodsA cross-sectional audit of health and nutrition claims, text and images used as ‘better-for-you’ features present on infant and toddler food packaging. Data on infant and toddler food packaging were collected from five large grocery stores in Adelaide, Australia in 2019. The content of 282 unique commercial products (n=215 infant foods, n=67 toddler foods) were analysed for explicit and implicit features positioning them as better-for-you, including health and nutrition claims as well as text and images representing ‘natural.’ResultsAt least one feature of better-for-you positioning was identified on all food packaging coded. All products had characteristics coded as ‘natural’. Almost one-fifth (17%) of the products included statements in addition to mandatory allergen labelling that their products were ‘free from’ certain allergens, or gluten. One-third of the labels had statements related to enhancing development of taste, oro-motor skills and other aspects of childhood development. Of the fruit and vegetable-based infant foods displaying a sugar statement suggesting a low sugar content, 85% were sweetened with fruit puree.ConclusionsThe use of better-for-you features on infant and toddler food packaging is common and pervasive. Allergen-free and developmental claims are being used to position infant and toddler foods as better-for-you. Regulation of toddler food products separately from adult food is required, as is tighter regulation of the appropriate use of sugar and fruit puree statements on infant and toddler food packaging.
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Affiliation(s)
- Lucy Simmonds
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Foundation for Alcohol Research and Education, Canberra, Canberra, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anthea Zee
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Merryn J Netting
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Pope DH, Karlsson JO, Baker P, McCoy D. Examining the Environmental Impacts of the Dairy and Baby Food Industries: Are First-Food Systems a Crucial Missing Part of the Healthy and Sustainable Food Systems Agenda Now Underway? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12678. [PMID: 34886406 PMCID: PMC8657189 DOI: 10.3390/ijerph182312678] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Food systems are increasingly being understood as driving various health and ecological crises and their transformation is recognised as a key opportunity for planetary health. First-food systems represent an underexplored aspect of this transformation. Despite breastfeeding representing the optimal source of infant nutrition, use of commercial milk formula (CMF) is high and growing rapidly. In this review, we examine the impact of CMF use on planetary health, considering in particular its effects on climate change, water use and pollution and the consequences of these effects for human health. Milk is the main ingredient in the production of CMF, making the role of the dairy sector a key area of attention. We find that CMF use has twice the carbon footprint of breastfeeding, while 1 kg of CMF has a blue water footprint of 699 L; CMF has a significant and harmful environmental impact. Facilitation and protection of breastfeeding represents a key part of developing sustainable first-food systems and has huge potential benefits for maternal and child health.
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Affiliation(s)
- Daniel H. Pope
- Centre for Primary Care and Public Health, Queen Mary University, London E1 4NS, UK;
| | - Johan O. Karlsson
- Department of Energy and Technology, Swedish University of Agricultural Sciences, 756 51 Uppsala, Sweden;
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3220, Australia;
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia
| | - David McCoy
- Centre for Primary Care and Public Health, Queen Mary University, London E1 4NS, UK;
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Nutrition and packaging characteristics of toddler foods and milks in Australia - CORRIGENDUM. Public Health Nutr 2021; 24:1175. [PMID: 33517941 DOI: 10.1017/s1368980020005182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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