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Pellegrino F, Tan M, Richonnet C, Reinert R, Bucher Della Torre S, Chatelan A. What Is the Nutritional Quality of Pre-Packed Foods Marketed to Children in Food Stores? A Survey in Switzerland. Nutrients 2024; 16:1656. [PMID: 38892589 PMCID: PMC11175003 DOI: 10.3390/nu16111656] [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: 04/19/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
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.
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Affiliation(s)
- Fabien Pellegrino
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Celine Richonnet
- Club Européen des Diététiciens de l’Enfance (CEDE), Esplanade, 17-7800 Ath, Belgium
| | - Raphaël Reinert
- Federal Food Safety and Veterinary Office, Schwarzenburgstrasse 155, 3003 Bern, Switzerland
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
| | - Angeline Chatelan
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland
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Soczynska I, da Costa BR, O'Connor DL, Jenkins DJ, Birken CS, Keown-Stoneman CD, Maguire JL. Plant-Based Milk Consumption and Growth in Children 1-10 Years of Age. J Nutr 2024; 154:985-993. [PMID: 38219863 DOI: 10.1016/j.tjnut.2023.12.046] [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: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] Open
Abstract
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.
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Affiliation(s)
- Izabela Soczynska
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Bruno R da Costa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Translational Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Catherine S Birken
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Ontario; Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada; Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles Dg Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada; Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Ontario; Child Health and Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
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Soczynska I, da Costa BR, O'Connor DL, Jenkins DJA, Birken CS, Keown-Stoneman CDG, D'Hollander C, Calleja S, Maguire JL. Effect of plant milk consumption on childhood growth: protocol for a systematic review. BMJ Open 2023; 13:e072466. [PMID: 37280020 PMCID: PMC10255015 DOI: 10.1136/bmjopen-2023-072466] [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: 02/03/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION There has been considerable debate about whether plant milks can support the nutritional requirements of growing children. The proposed systematic review aims to assess the evidence on the relationship between plant milk consumption and growth and nutritional status in childhood. METHODS AND ANALYSIS Ovid MEDLINE ALL (1946-present), Ovid EMBASE Classic (1947-present), CINAHL Complete (Cumulative Index to Nursing and Allied Health Literature), Scopus, the Cochrane Library and grey literature will be searched comprehensively (from 2000 to present; English language) to find studies that describe the association between plant milk consumption and growth or nutrition in children 1-18 years of age. Two reviewers will identify eligible articles, extract data and assess the risk of bias in individual studies. If a meta-analyses is not conducted, the evidence will be synthesised narratively and the overall certainty of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Ethical approval is not required for this study since no data will be collected. Results of the systematic review will be published in a peer-reviewed journal. Findings from this study may be useful in informing future evidence-based recommendations about plant milk consumption in children. PROSPERO REGISTRATION NUMBER CRD42022367269.
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Affiliation(s)
- Izabela Soczynska
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Bruno R da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Applied Health Research Centre (AHRC), St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Curtis D'Hollander
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sabine Calleja
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Soczynska I, da Costa BR, O'Connor DL, Jenkins DJA, Birken CS, Juando-Prats C, Maguire JL. Parent and physician beliefs, perceptions and knowledge of plant milks for children. Nutr Health 2023:2601060231171299. [PMID: 37157791 DOI: 10.1177/02601060231171299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
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.
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Affiliation(s)
- Izabela Soczynska
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
| | - Bruno R da Costa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
- Translational Medicine, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Translational Medicine, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
| | - Catherine S Birken
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Clara Juando-Prats
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
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Brusati M, Baroni L, Rizzo G, Giampieri F, Battino M. Plant-Based Milk Alternatives in Child Nutrition. Foods 2023; 12:foods12071544. [PMID: 37048365 PMCID: PMC10094203 DOI: 10.3390/foods12071544] [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: 02/05/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
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.
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Affiliation(s)
- Marco Brusati
- Pediatric and Educational Center "La Volpe e il Canguro", 25062 Concesio, Italy
| | - Luciana Baroni
- Scientific Society for Vegetarian Nutrition, 30171 Venice, Italy
| | - Gianluca Rizzo
- Independent Researcher, Via Venezuela 66, 98121 Messina, Italy
| | - Francesca Giampieri
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
| | - Maurizio Battino
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
- Department of Clinical Specialistic and Odontostomatological Sciences, University Polytechnic of Marche, 60131 Ancona, Italy
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Drewnowski A. 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. Nutrients 2022; 14:4767. [PMID: 36432454 PMCID: PMC9695877 DOI: 10.3390/nu14224767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, P.O. Box 353410, Seattle, WA 98195, USA
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