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Mathias FB, Cademartori MG, Buffarini R, Barros F, Bertoldi AD, Demarco FF, Goettems ML. Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study. Int J Paediatr Dent 2024; 34:103-113. [PMID: 37171456 DOI: 10.1111/ipd.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC). AIM To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF). DESIGN Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated. RESULTS Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001). CONCLUSION High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.
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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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Hoteit M, Ibrahim C, Nohra J, Sacre Y, Hanna-Wakim L, Al-Jawaldeh A. Assessment of the Composition of Breastmilk Substitutes, Commercial Complementary Foods, and Commercial Snack Products Commonly Fed to Infant and Young Children in Lebanon: A Call to Action. Nutrients 2023; 15:nu15051200. [PMID: 36904200 PMCID: PMC10005724 DOI: 10.3390/nu15051200] [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: 12/21/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Nutrition for optimum growth and physical development is acquired by adequate infant feeding practices. (2) Methods: One hundred seventeen different brands of infant formulas (n = 41) and baby food products (n = 76) were selected from the Lebanese market and were analyzed for their nutritional content. (3) Results: Saturated fatty acid content was detected to be the highest in follow-up formulas (79.85 g/100 g) and milky cereals (75.38 g/100 g). Among all saturated fatty acids, palmitic acid (C16:0) accounted for the greatest proportion. Moreover, glucose and sucrose were the predominant added sugars in infant formulas, while sucrose was the main added sugar in baby food products. Our data showed that the majority of the products were non-compliant to the regulations and the manufacturers' nutrition facts labels. Our results stated also that the contribution to the daily value for the saturated fatty acids, added sugars, and protein exceeded the daily recommended intake for most infant formulas and baby food products. (4) Conclusions: This requires careful evaluation from policymakers in order to improve the infant and young children feeding practices.
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Affiliation(s)
- Maha Hoteit
- Food Sciences Unit, National Council For Scientific Research (CNRS), Beirut P.O. Box 11-8281, Lebanon
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
| | - Carla Ibrahim
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
- Doctoral School of Sciences and Technology (DSST), Lebanese University, Hadath 1533, Lebanon
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Joanna Nohra
- PHENOL Research Group (Public HEalth Nutrition prOgram Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Lebanese University Nutrition Surveillance Center (LUNSC), Lebanese Food Drugs and Chemical Administrations, Lebanese University, Beirut 6573, Lebanon
- Doctoral School of Sciences and Technology (DSST), Lebanese University, Hadath 1533, Lebanon
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Yonna Sacre
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Lara Hanna-Wakim
- Department of Agricultural and Food Engineering, School of Engineering, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt
- Correspondence:
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Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, Ribeiro Neves PA, Pérez-Escamilla R, Richter L, Russ K, Sen G, Tomori C, Victora CG, Zambrano P, Hastings G. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet 2023; 401:486-502. [PMID: 36764314 DOI: 10.1016/s0140-6736(22)01931-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.
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Affiliation(s)
- Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
| | | | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | | | | | - Linda Richter
- University of the Witwatersrand, DSI-NRF Centre of Excellence in Human Development, Johannesburg, South Africa
| | - Katheryn Russ
- Department of Economics, University of California, Davis, CA, USA
| | - Gita Sen
- Public Health Foundation of India, Bangalore, India
| | - Cecília Tomori
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
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Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico. Global Health 2023; 19:8. [PMID: 36726118 PMCID: PMC9890409 DOI: 10.1186/s12992-023-00908-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children's feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. METHODS Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. RESULTS Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. CONCLUSIONS Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children's right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.
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Awad R, Kowash M, Hussein I, Salami A, Abdo M, Al-Halabi M. Sugar content in infant formula: Accuracy of labeling and conformity to guidelines. Int J Paediatr Dent 2023; 33:63-73. [PMID: 35789006 DOI: 10.1111/ipd.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/26/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infant formulae are a primary source of nutrition during the first years of life, to which sugars are frequently added. This may contribute to adverse dental health problems if consumed excessively when coupled with prolonged and nocturnal feeding habits. AIM To assess the amount and type of dietary sugars in commercially available infant formulae in the UAE. DESIGN Sucrose, glucose, and fructose were measured in 71 different brands of commercially available infant formulae for retail sale in the UAE. Analysis was performed using high-performance liquid chromatography with refractive index detection. Sugar values were compared with the reported levels on the nutritional labels. A comparison between findings, product labels, and international standards for infant formulae was performed. RESULTS Of the 71 samples, 23 had detectable sugar levels, varying between sucrose, glucose, and fructose. Ten samples were found to have sugars contributing to more than 5% of total energy intake ranging between 5.68% and 27.06%. All infant formula packages had carbohydrate levels mentioned on the labels, but very few mentioned the added sugar content. CONCLUSIONS Many infant formula products tested contained sugars that exceeded the standard recommended intake. Tighter regulations that monitor the amount of sugar in infant formulae and guidelines for comprehensive labeling systems are required.
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Affiliation(s)
- Rawan Awad
- Department of Pediatric Dentistry, Tufts University School of Dental Medicine, Boston, USA
| | - Mawlood Kowash
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iyad Hussein
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Anas Salami
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohamed Abdo
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Manal Al-Halabi
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Belyaeva IA, Namazova-Baranova LS, Bombardirova EP, Turti TV. World Trends in Infant Formulas Composition Enhancement. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i6.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article provides the overview of the major strategies for infant formulas composition enhancement via modern technologies and trends in minimizing technology-related loads on the environment. Potential modifications of quantitative and qualitative characteristics of milk formulas nutrients have been determined. We also covered product contents changing over age, as well as the perspectives of using animal milk in formulas. The relevance of adding biologically active substances and living microorganisms (probiotics), their safety, and efficacy are discussed.
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Affiliation(s)
- Irina A. Belyaeva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Morozovskaya Children’s City Hospital
| | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Elena P. Bombardirova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | - Tatiana V. Turti
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Research Institute for Healthcare Organization and Medical Management
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Becker GE, Zambrano P, Ching C, Cashin J, Burns A, Policarpo E, Datu-Sanguyo J, Mathisen R. Global evidence of persistent violations of the International Code of Marketing of Breast-milk Substitutes: A systematic scoping review. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13335. [PMID: 35313063 PMCID: PMC9113471 DOI: 10.1111/mcn.13335] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/03/2023]
Abstract
The influence of marketing on infant and young child feeding and health is well recognized, and an International Code was adopted by the World Health Assembly (WHA) in 1981 to reduce inappropriate marketing and protect breastfeeding. Yet the marketing and influencing continue. This scoping review systematically examined the published research evidence on the nature and extent of exposure to International Code violations from 1981 to August 2021. We used several search strategies involving multi‐language databases, organization websites, citation tracking, and expert consultation, to find research items meeting our inclusion criteria. We evaluated 657 items and retained 153 studies from at least 95 countries in the review. The majority of the studies (n = 113) documenting exposure to inappropriate marketing were published since 2010. Studies reported a broad range of marketing violations targeting mothers and families, health workers, and the general public. Marketing via digital platforms and brand extension has become more frequent. The evidence shows the use of misleading and inaccurate labeling and health and nutrition claims in breach of the Code. Our review confirms that violations of the Code have not ceased and calls for renewed attention from the WHA and national governments to protect the health of children and their mothers. Exposure to inappropriate marketing continues across the world in health systems, public spaces, points of sale, media, emergency programs, and direct to mothers. Studies have documented the emergence of products and marketing practices designed to circumvent the Code. Labeling and health and nutrition claims were found that were misleading, inaccurate, and in breach of the Code. Evidence of marketing through social media and other digital platforms has increased over time. Future research, guidance, and policies would benefit from an accessible central repository of comprehensive and comparable measurement tools and evidence.
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Affiliation(s)
| | - Paul Zambrano
- Alive & Thrive Southeast Asia/FHI 360, Manila, Philippines
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI 360, Washington, District of Columbia, USA
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Washington, District of Columbia, USA
| | | | | | | | - Roger Mathisen
- Alive & Thrive Southeast Asia/FHI 360, Manila, Philippines
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Vilar‐Compte M, Hernández Cordero S, Castañeda‐Márquez AC, Rollins N, Kingston G, Pérez‐Escamilla R. Follow‐up and growing‐up formula promotion among Mexican pregnant women and mothers of children under 18 months old. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13337. [PMID: 35293129 PMCID: PMC9113472 DOI: 10.1111/mcn.13337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mireya Vilar‐Compte
- Department of Public Health Montclair State University Montclair New Jersey USA
| | - Sonia Hernández Cordero
- Research Institute for Equitable Development (EQUIDE) Universidad Iberoamericana Mexico City Mexico
| | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health Geneva Switzerland
| | | | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
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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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Pries AM, Mulder A, Badham J, Sweet L, Yuen K, Zehner E. Sugar content and nutrient content claims of growing-up milks in Indonesia. MATERNAL & CHILD NUTRITION 2021; 17:e13186. [PMID: 33830660 PMCID: PMC8476439 DOI: 10.1111/mcn.13186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/03/2023]
Abstract
'Growing-up milks' (GUMs)-breast-milk substitutes targeted for young children (aged 12-36 months)-are commonly consumed in Indonesia. The World Health Assembly has stated that GUMs are not necessary for proper growth and development, and recently, the American Academy of Pediatrics declared that such products are not recommended for young children due to their common use of sweeteners. To contribute to the evidence base on the composition of GUMs and their appropriateness for young child diets, this cross-sectional study documented the declared sugar content and presence of nutrient content claims of 99 GUMs newly launched in Indonesia between January 2017 and May 2019. Sugar content was evaluated against the draft 2018 Codex Alimentarius Standard for Follow-Up Formula guidance on sugar content and the United Kingdom Food Standard Agency's front-of-pack (UK FSA FOP) colour coding system for sugar. Almost all (97%) GUMs contained one or more added sugars. None of the products were fully compliant with all three sugar content recommendations in the draft Codex standard. Seventy-one per cent of GUMs were determined to have high sugar content according to the UK FSA FOP system. Nutrient content claims were found on 97% of GUMs. Median total sugar content was 7.3 g per 100 ml, similar to sugar content levels in sugar-sweetened beverages. Many GUMs available in Indonesia claim to offer nutritional benefits; however, the current levels of sugar content in GUMs are a serious concern and are inappropriate for inclusion in the diets of young children.
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Affiliation(s)
- Alissa M. Pries
- Helen Keller InternationalHeadquartersWashingtonDistrict of ColumbiaUSA
| | | | | | | | - Katelyn Yuen
- Helen Keller InternationalHeadquartersWashingtonDistrict of ColumbiaUSA
| | - Elizabeth Zehner
- Helen Keller InternationalHeadquartersWashingtonDistrict of ColumbiaUSA
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Kong KL, Burgess B, Morris KS, Re T, Hull HR, Sullivan DK, Paluch RA. Association Between Added Sugars from Infant Formulas and Rapid Weight Gain in US Infants and Toddlers. J Nutr 2021; 151:1572-1580. [PMID: 33880550 PMCID: PMC8169810 DOI: 10.1093/jn/nxab044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 02/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Formulas often contain high amounts of added sugars, though little research has studied their connection to obesity. OBJECTIVES This study assessed the contribution of added sugars from formulas during complementary feeding on total added sugar intakes, and the association between these sugars and upward weight-for-age percentile (WFA%) crossing (i.e., participants crossing a higher threshold percentile were considered to have an upward crossing). METHODS Data from three 24-hour dietary recalls for infants (n = 97; 9-12 months) and toddlers (n = 44; 13-15 months) were obtained in this cross-sectional analysis. Foods and beverages with added sugars were divided into 17 categories. Pearson's correlations were used to test relations between added sugar intake and upward WFA% crossing, followed by multivariable regressions when significant. ANOVA compared intakes of all, milk-based, and table foods between primarily formula-fed compared with breastfed participants. Multivariable regressions were used to test effects of added sugars and protein from all foods compared with added sugars and protein from milk-based sources on upward WFA% crossing. RESULTS Added sugars from formulas comprised 66% and 7% of added sugars consumed daily by infants and toddlers, respectively. A significant association was observed between upward WFA% crossing and added sugars from milk-based sources after controlling for gestational age, sex, age, introduction to solid foods, mean energy intakes, and maternal pre-pregnancy BMI and education (β = 0.003; 95% CI, 0.000-0.007; P = 0.046). Primarily formula-fed participants consumed nearly twice the energy from added sugars (P = 0.003) and gained weight faster (upward WFA% crossing = 1.1 ± 1.2 compared with 0.3 ± 0.6, respectively; P < 0.001) than their breastfed counterparts. CONCLUSIONS Added sugars in formulas predict rapid weight gain in infants and toddlers. Educating mothers on lower-sugar options may enhance childhood obesity prevention.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children’s Mercy Research Institute, Children’s Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri- Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brenda Burgess
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Katherine S Morris
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Tyler Re
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children’s Mercy Research Institute, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Holly R Hull
- Department of Dietetics and Nutrition, Kansas University Medical Center, University of Kansas, Kansas City, KS, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, Kansas University Medical Center, University of Kansas, Kansas City, KS, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Abstract
OBJECTIVE To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification. DESIGN Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification. SETTING Supermarkets and pharmacies in Australia. RESULTS A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow's milk per 100 ml. Claims and messages were present on 99 % of foods and all milks. CONCLUSIONS The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.
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Sumner O, Burbridge L. Plant-based milks: the dental perspective. Br Dent J 2020:10.1038/s41415-020-2058-9. [PMID: 32918058 DOI: 10.1038/s41415-020-2058-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 02/06/2023]
Abstract
Background Consumption of plant-based milk in the UK is increasing at the expense of cow's milk. Cow's milk consumption has traditionally been advocated by the dental profession as 'good for teeth'.Aims To identify the range of plant-based milks available in the UK and compare their nutritional benefits with cow's milk. A secondary aim was to explore reasons behind the increase in popularity of plant-based milks and discuss dental relevance.Methods Branded plant-based milks available in UK supermarkets were identified and nutritional data collected. Data were obtained from product labelling and manufacturer websites. The sample was collected in December 2019.Results Eighty-two products were identified. Differences were observed between plant-based and cow's milk, in particular regarding calcium, iodine, vitamin B12 and sugar content. Sugar content varied from 0-7.6 g/100 ml.Conclusions Dairy is a key source of dietary iodine and many plant-based milks contain much lower levels. Many plant-based milks contain free sugars which are cariogenic. Dentists should be aware of this emerging market and be able to advise patients accordingly.
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Affiliation(s)
- Oliver Sumner
- Post-CCST StR in Paediatric Dentistry, Newcastle Dental Hospital, Child Dental Health, Richardson Road, Newcastle upon Tyne, NE2 4AZ, UK.
| | - Lucy Burbridge
- Consultant in Paediatric Dentistry, Newcastle Dental Hospital, Child Dental Health, Richardson Road, Newcastle upon Tyne, NE2 4AZ, UK
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