Physician and Parent Perceptions on Plant-Based Beverages as Substitutes for Cow's Milk: A Single City Survey

What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland

Food marketing targeting children influences their choices and dietary habits, and mainly promotes food high in fat, sugar, and salt as well as ultra-processed food. The aim of this study was to assess the nutritional quality of food and beverages marketed to children over the age of 3 and available on the Swiss market. Products with at least one marketing technique targeting children on the packaging were selected from five food store chains. Three criteria to assess nutritional quality were used: (1) nutritional composition (using the Nutri-Score), (2) degree of processing (NOVA classification), and (3) compliance with the World Health Organization (WHO) Nutrient Profile Model (NPM). A total of 735 products were found and analyzed. The most common marketing techniques used were childish names/fonts (46.9%), special characters (39.6%), and children's drawings (31.3%). Most products had a Nutri-Score of D or E (58.0%) and were ultra-processed (91.8%). Only 10.2% of products displayed the Nutri-Score. The least processed products generally had a better Nutri-Score (p < 0.001). Most products (92.8%) did not meet the criteria of the WHO NPM. Products that met the WHO NPM criteria, organic products, and products with a nutritional claim generally had a better Nutri-Score and were less processed (ps < 0.05). Pre-packaged foods and beverages marketed to children in the Swiss market were mostly of poor nutritional quality. Public health measures should be adopted to improve the nutritional quality of foods marketed to children in Switzerland and restrict the marketing of unhealthy foods to children.

Plant-Based Milk Consumption and Growth in Children 1-10 Years of Age

BACKGROUND

The effects of plant-based milk consumption on the growth of children are unclear.

OBJECTIVES

We aimed to evaluate the relationship between plant-based milk consumption and BMI in childhood. Secondary objectives were to examine the association with height and whether these relationships are mediated by dairy milk intake and modified by age or the type of plant-based milk consumed.

METHODS

A prospective cohort study was conducted in healthy children aged 1-10 y through the TARGet Kids! primary care research network in Toronto, Canada. Linear mixed-effect modeling and logistic generalized estimating equations were used to evaluate the association between plant-based milk consumption (number of 250 mL cups/d) and BMI. A mediation analysis was conducted to examine whether dairy milk intake mediated these relationships. Effect modification by age and type of plant-based milk was explored.

RESULTS

Among 7195 children (mean age: 3.1 y; 52.3% male), higher plant-based milk consumption was associated with lower BMI (P = 0.0002) and height (P = 0.005). No association was found with BMI categories. Lower dairy milk intake partially mediated these relationships. A child aged 5 y who consumed 3 cups of plant-based milk compared with 3 cups of dairy milk had a lower weight of 0.5 kg and lower height of 0.8 cm. Associations did not change over time and were similar for children who consumed soy milk compared with other plant-based milks.

CONCLUSIONS

Plant-based milk consumption was associated with lower BMI and height, but both were within the normal range on average. Future longitudinal studies are needed to determine whether these associations persist over time.

Parent and physician beliefs, perceptions and knowledge of plant milks for children

Background: Parent and physician perceptions of plant milk are unclear. Aim: To explore parent and physician perceptions of plant milk for children and to gain a better understanding of why parents and physicians might choose plant milk for children. Methods: A mixed methods study was conducted using a questionnaire and interviews with parents and physicians participating in the TARGet Kids! cohort study. Questionnaire data were analyzed using descriptive statistics. Interview transcripts were analyzed using thematic analysis. Results: Parents reported a variety of reasons for choosing plant milk for their children including concerns around allergies, the environment, animal welfare, plant-based diet, health benefits, taste and hormones in cow's milk. Parents gave their children various types of plant milks and physicians provided various recommendations to parents of children not consuming cow's milk. Our study identified that 79% of parents and 51% of physicians were unaware that soy milk is the recommended cow's milk substitute for children. Additionally, 26% of parents did not know some plant milks are not fortified and can contain added sugar. Three main themes were identified from interviews about why parents and physicians may choose plant milk for children: (i) healthiness of plant milk; (ii) concerns about hormones; and (iii) environmental impacts. Conclusions: Parents and physicians choose the milk that they believe is healthiest for their child or patient. However, a lack of clarity on the effects of plant milk consumption on children's health resulted in conflicting views on whether plant milk or cow's milk is healthier for children.

Plant-Based Milk Alternatives in Child Nutrition

Plant-based milk alternatives can be distinguished in two main categories, differing in production processes and regulation: plant-based formulas and plant-based drinks. They are now a widely accepted class of products on the international market. The various plant-based milk alternatives differ in nutritional characteristics due to their origin and manufacturing; more importantly, whereas formulas from plant and cow origin can be used interchangeably, plant-based drinks are nutritionally different from cow's milk and can be consumed by children subsequently to the use of formula. Several scientific organizations have expressed differing opinions on the use of these products in the diets of children. In the face of unanimous conclusions regarding the use of these products during the first year of life, in subsequent ages there were conflicting opinions regarding the timing, quantities, and type of product to be used. From the viewpoint of the child's overall diet and health, it could be suggested that these foods be considered not as simple substitutes for cow's milk, but as part of a varied diet, within individual advice of use. We suggest accepting the presence of these products in a baby's diet (omnivores included), planning their use correctly in the context of a balanced diet, according to the specific product and the needs of the individual.

Most Plant-Based Milk Alternatives in the USDA Branded Food Products Database Do Not Meet Proposed Nutrient Standards or Score Well on Nutrient Density Metrics

Plant-based milk alternatives and plant-based waters are of variable nutritional value. The present objective was to assess nutrient density of all plant-based beverages in the US Department of Agriculture Branded Food Products Database and determine whether plant-based milk alternatives met the proposed nutrient standards. Plant-based milk alternatives (n = 1042) were identified as almond, soy, coconut, cashew, other tree nut, flax/hemp, pea, and oat, quinoa, and rice products. Plant-based waters (n = 550) were coconut, aloe, tree, fruit, and plain. Machine searches of ingredient lists identified products with added sugars, salt, vitamins, and minerals. Plant-based milk alternatives were tested for compliance with previously developed nutrient standards. The Nutrient Rich Food Index (NRF5.3), two versions of Nutri-Score, and Choices International were the nutrient density metrics. Plant-based milk alternatives had mean energy density of 49 kcal/100 g, were low in protein (~1.1 g/100 g), often contained added sugars and salt, and tended to be fortified with calcium, vitamin A, vitamin D, and vitamin B12. Only 117 milk alternatives (11.2%) met nutrient standards and only 80 (7.7%) met the more stringent “best of class” standards for ≥2.8 g/100 g protein and <3.1 g/100 g added sugars. The latter were mostly soy milks. Nutri-Score grades varied depending on whether the beverages were treated as beverages or as solid foods, as is currently required. The highest NRF5.3 scores were given to soy, almond, and tree nut milk alternatives. Plant-based waters had low energy density (~23 kcal/100 g), contained added sugars (4.6 g/100 g), and some had added vitamin C. Applying nutrient standards to plant-based milk alternatives can aid new product development, promote more transparent labeling, and inform potential regulatory actions. Guidance on minimum protein content, maximum recommended amounts of fat, added sugars, and sodium, and consistent fortification patterns would be of value to regulatory agencies and to the food industry.