Search

Although commercially produced complementary foods (CPCFs) are increasingly sold throughout Southeast Asia, concerns have been raised about CPCFs nutritional quality, labelling practices and the strength and scope of national CPCF regulations. The Consortium for Improving Complementary Foods in Southeast Asia (COMMIT), composed of UN agencies and civil society organizations, was formed to assess the nutrient gap in the diets of young children and the consumer, product and policy landscapes for CPCFs in seven Southeast Asian countries. Results from a nutrient gap assessment indicate that the diets of children aged 6–23 months are suboptimal and deficient in micronutrients. A consumer survey revealed that caretakers commonly use CPCFs, are conscious of the importance of nutrition and are influenced by label claims. Results from a CPCF benchmarking showed that many products sold in Southeast Asia contained added sugar or sweeteners, had a high total sugar and/or high sodium content and that no CPCF product adhered to all recommended labelling practices. Further, a legal review of national binding legal measures relevant to CPCFs showed minimal alignment with available global guidance. Urgent actions are necessary to strengthen national regulations related to CPCF nutrient composition and labelling practices. To speed progress, COMMIT developed a compendium of existing standards and global guidance to help countries align their national regulations with CPCF composition, labelling and production recommendations. Advocacy to garner public support for new or improved CPCF regulations, as well as strong government monitoring and enforcement of regulations, is crucial to support efforts to safeguard and improve the diets of older infants and young children in Southeast Asia. Key message: Poor diet quality is a major driver of the triple burden of malnutrition in Southeast Asia, where food environments are rapidly changing and commercially produced complementary foods (CPCFs) are widely available.CPCFs are routinely purchased for children 6–23 months of age because of their convenience and perceived nutritional value. COMMIT (Consortium for Improving Complementary Foods in Southeast Asia) found that caregivers' purchasing decisions are strongly influenced by CPCF labelling claims related to naturalness and healthfulness.Many CPCFs sold are fortified with micronutrients; however, 62% of cereals and ready‐to‐eat foods and 85% of snack and finger foods did not meet global nutritional standards and no products fully conformed to global CPCF labelling standards, which include the prohibition of claims.CPCFs that do not adhere to recommended nutrient composition and labelling requirements are unsuitable for children 6–36 months and should be prohibited from promotion. Legal measures in the seven countries studied are insufficient and require urgent action. A compendium of existing CPCF standards and global guidance, developed by COMMIT, can be used as a resource to update and strengthen national legislation to safeguard older infants and young child nutrition. [ABSTRACT FROM AUTHOR]

The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF‐specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6–36 months of age. Key messages: Given the proliferation of commercially produced complementary foods (CPCF) in Southeast Asia, national binding legal measures are essential to ensure CPCF are nutritionally suitable for older infants and young children (IYC), and are labelled in a manner that does not mislead caregivers.All seven Southeast Asian countries included in this review were found to have at least two national binding legal measures related to the nutrient composition and/or labelling practices of CPCF. However, there was limited alignment between these binding legal measures and the available guidance documents.No country was fully aligned with the six relevant Codex Alimentarius (Codex) standards and only one country was fully aligned with guidance from the World Health Organization (WHO). Existing binding legal measures do not ensure that CPCF are nutritionally adequate and labelled in a responsible way that enables caregivers to make healthy choices for older IYC.Countries in Southeast Asia urgently require consolidated guidance on how to develop appropriate, legally binding and enforceable standards for CPCF nutrient composition and labelling. Existing guidance is fragmented and Codex standards are outdated and insufficient for this purpose. [ABSTRACT FROM AUTHOR]

Commercially produced complementary foods (CPCF) have the potential to fill nutritional gaps in the diets of older infants and young children. This study evaluated the accuracy of nutrient declarations on labels of 43 commonly available CPCF in three peri‐urban/urban locations: Khsach Kandal district, Cambodia (n = 11); Bandung, Indonesia (n = 11) and Guédiawaye and Dakar departments, Senegal (n = 21). Label values (LV) from product nutrient declarations were compared to analytical values (AV) derived from laboratory nutrient analysis for macronutrients (carbohydrate, protein and total fat), nutrients of public health concern (saturated fat, total sugar and sodium), and micronutrients of interest (calcium, iron and zinc). European Union guidance for nutrition label accuracy was used to set tolerance ranges for each nutrient LV relative to AV. LV were missing for one or more nutrients in 88.4% (n = 38) of the CPCF products and no CPCF met EU tolerance thresholds for all nine nutrients assessed. Over half of products with LV for key micronutrients (55.6%, n = 10/18) and macronutrients (54.8%, n = 23/42) met tolerances for LV accuracy. Eighty‐five percent (n = 11/13) of products with LV for nutrients of public health concern were determined to be accurate. Nutrient content claims for iron appeared on 19 (44.2%) of the 43 products. Of the products which made an iron content claim, 26.3% had inaccurate LV with the majority of these containing less iron than declared. Regulatory action is needed to ensure that CPCF labelling communicates complete and accurate nutrient content information that enables caregivers to make informed decisions for feeding older infants and young children. Key messages: None of the 43 commercially produced complementary food (CPCF) products assessed met tolerance thresholds for nutrient label value accuracy, either because of missing nutrient label information or discrepancies with laboratory derived analytical values.The proportion of accurate nutrient label values for individual nutrients ranged from 54.2% (n = 13/24) for calcium to 94.7% (n = 36/38) for sodium.While infant cereals generally had high proportions of accurate label values for the nine nutrients assessed, fewer than half of snacks/finger foods (e.g. rusks/biscuits) had accurate label values for protein and calcium and only a third were accurate for zinc.Nutrient content claims were prevalent across the 43 CPCF products, which can create a 'health halo' (the perception that something is healthy without direct evidence) for these products. However, over half of products with nutrient content claims for iron and calcium were found to contain lower levels of these micronutrients when compared to analytical values. These products were found to overstate iron content and calcium content by a median of 4.71 mg per 100 g product and 101.7 mg per 100 g product, respectively.Nutrient content claims and nutrient declarations should be regulated and monitored by national authorities to ensure accurate labelling of CPCF. Manufacturers of CPCF have a responsibility to provide consumers with correct product information and should be accountable for the content of CPCF nutrient declarations. [ABSTRACT FROM AUTHOR]

'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. [ABSTRACT FROM AUTHOR]

National legislation and global guidance address labelling of complementary foods to ensure that labels support optimal infant and young child feeding practices. This cross‐sectional study assessed the labels of commercially produced complementary foods (CPCF) sold in Phnom Penh (n = 70), Cambodia; Kathmandu Valley (n = 22), Nepal; Dakar Department (n = 84), Senegal; and Dar es Salaam (n = 26), Tanzania. Between 3.6% and 30% of products did not provide any age recommendation and 8.6−20.2% of products, from all sites, recommended an age of introduction of <6 months. Few CPCF products provided a daily ration (0.0−8.6%) and 14.5−55.6% of those that did exceeded the daily energy recommendation for complementary foods for a breastfed child from 6 to 8.9 months of age. Only 3.6−27.3% of labels provided accurate and complete messages in the required language encouraging exclusive breastfeeding, and almost none (0.0−2.9%) provided accurate and complete messages regarding the appropriate introduction of complementary foods together with continued breastfeeding. Between 34.3% and 70.2% of CPCF manufacturers also produced breastmilk substitutes and 41.7−78.0% of relevant CPCF products cross‐promoted their breastmilk substitutes products. Labelling practices of CPCF included in this study do not fully comply with international guidance on their promotion and selected aspects of national legislation, and there is a need for more detailed normative guidance on certain promotion practices in order to protect and promote optimal infant and young child feeding. [ABSTRACT FROM AUTHOR]

This cross‐sectional survey assessed the characteristics of labels of follow‐up formula (FUF) and growing‐up milk (GUM) compared with infant formula (IF), including cross‐promotion practices between FUF/GUM and IF manufactured by the same company, sold in Phnom Penh, Cambodia; Kathmandu Valley, Nepal; Dakar Department, Senegal; and Dar es Salaam, Tanzania. All products were imported. A wide recommended age/age range for introduction was provided by manufacturers across all sites, with products with an age recommendation of 0–6 months being most prevalent in three sites, representing over a third of all products. Various age categories (e.g. 1, 1+ and Stage 1) commonly appeared on labels. A number of descriptive names (e.g. infant formula and milk formula) per category of age of introduction were used with some appearing across more than one category. Images of feeding bottles were found on most labels across all age categories, but prevalence decreased with older age categories. The majority of FUF/GUM manufactured by IF companies across all sites displayed at least one example of cross‐promotion with one or more of the company's IF: two‐thirds or more contained similar colour schemes/designs and similar brand names; 20–85% had similar slogans/mascots/symbols. A wide and potentially confusing range of ages/categories of introduction and descriptive names were found, and cross‐promotion with IF was common on FUF/GUM labels. Global guidance from normative bodies forms the basis of most low and middle income countries policies and should provide specific guidance to prohibit cross‐promotion between FUF/GUM and IF, and all three categories should be classified as breastmilk substitutes. [ABSTRACT FROM AUTHOR]

The author discusses the critical issue of ensuring optimal breastfeeding and complementary feeding to improve child nutrition in developing countries. She states that there is universal agreement as to what infant and young child feeding (IYCF) interventions need to be implemented and scaled-up. According to her, an integrated approach to infant and young child feeding that not only protects and promotes breastfeeding, but also addresses adequate complementary feeding is needed.

Studies linking diet and health and consumers' demand for health information, has led to an increasing awareness of the role of nutrition in health and disease. Interest in soy foods and an awareness of its health benefits has also increased. The objective was to assess South African (SA) consumers' opinions and beliefs regarding the health benefits of soy and soy products using different statements. This cross-sectional study randomly selected 3001 respondents from metropolitan and rural areas in South Africa. Data of 81% of respondents ( n = 2437), who had heard of soy, were used. Trained fieldworkers administered questionnaires as face-to-face interviews. Fifteen statements probing consumers' opinions regarding the health benefits of soy were used. The data were weighted to be representative of the total South Africa adult population ( n = 18 251 000) based on gender, age, living environment and race distribution in 2000. Effect sizes were used to determine the strength of associations (practical significance), since statistical significance could be attributed to the large study population. No practically significant differences between either gender or age groups, or between rural and metropolitan respondents' opinions were found. Most respondents in the total study population (50-75%), as well as within all race groups agreed that soy has many health benefits; soy is good for you; soy lowers cholesterol; soy is good for people with a milk allergy; soy helps keep your heart healthy; soy is good for diabetes and soy is good for growing children. Medium to large practically significant differences were found between racial groups regarding some of the statements. Practically significantly more adult Black consumers believed that soy is only for people with a low-income, and fewer that soy milk is good for people with a milk allergy than did White, Indian and Coloured consumers. Whites were relatively more positive towards the use of soy for people with a milk allergy opposed to Blacks, while Blacks were relatively more positive than Whites towards the statement that soy helps keep your bones strong. The results indicate that SA consumers held positive opinions and associate consumption of soy with several health benefits. The role of soy is seen more as being preventative than curative. It may represent a challenge to the food industry to design soy-containing products that appeal to a broader spectrum of consumers. [ABSTRACT FROM AUTHOR]

Interest in soy foods has increased with consumer awareness of its health benefits, especially with soy-related ingredients being utilized as one of the major sources of high-protein fortification. The aim of the present study was to assess South African (SA) consumers' opinion of soy and soy products through different statements on consumption, taste, protein value and healthiness. The respondents ( n = 3001) for this randomized cross-sectional study were randomly selected from metropolitan and rural areas in South Africa. Trained fieldworkers administered questionnaires by conducting face-to-face interviews. Fourteen statements from four sections of the questionnaire (consisting of 17 food-related topics in total), probing information on consumers' opinion on soy and soy products, were used. Data on 81% of the respondents ( n = 2437), who had heard of soy before, were used for statistical analyses. The data were weighted to be representative of the total SA population based on gender, age and race. No practically significant differences among metropolitan and rural respondents' opinion, gender or age variables regarding any statement were found. A practically significant higher percentage (>60%) of respondents in the total population and within all race groups were positive about soy and agreed that soy is a good source of protein, has many health benefits, associated soy with meat substitutes, were aware of a number of meat substitutes and agreed that soy can replace meat in their diet. Medium to large practically significant differences were found between racial groups regarding certain statements. More Blacks and Indians (76% and 68% respectively) than Whites (25%) use soy. Almost two-thirds of Indians (65%) and Blacks (64%) eat or drink soy products, compared with only 22% for Whites, indicating that the potential target market for soy products should be chosen accordingly. Higher percentages of Blacks than Whites also indicated that they liked the taste of soy, would use more soy if it was readily available and if a bigger product range existed and would replace cow's milk with soy milk, confirming that Blacks are more positive about soy and would use even more soy if a bigger range of soy products were available. The findings from the current study indicated that more than 70% of SA consumers believe that soy has many health benefits and more than 60% already use soy. Insight gained from this first study of its kind in SA provided valuable information to developers and marketers, and signified that consumer segmentation should be taken into consideration to focus on developing more acceptable soy products that appeal to these consumer segments that are more positive towards the taste of soy and might consume soy regularly. Within the discipline of Consumer Science, efforts to inform consumers about the advantages of soy in terms of its health benefits, and to support it in terms of a greater availability of more acceptable soy products at reasonable prices, would support the ideal of informed, responsible buying decisions across all socio-economic groups. [ABSTRACT FROM AUTHOR]

Promotion of breast milk substitutes (BMS) and inappropriate marketing of commercially produced complementary foods (CPCF), including through television, can negatively influence infant and young child feeding. The World Health Organization International Code of Marketing of Breast‐milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions prohibit such advertising and require manufacturers and distributors to comply with its provisions; however, such regulations at national level may vary. Advertisements require Ministry of Health approval in Cambodia but are not regulated in Senegal. Television stations were monitored for 13 months in Phnom Penh and for 3 months in Dakar to assess advertisements for BMS and CPCF. Ten television channels (out of 16) in Phnom Penh and four (out of 20) in Dakar aired advertisements for BMS. Three and five channels, respectively, aired advertisements for CPCF. All BMS advertised in Phnom Penh were for children over 1 year of age. BMS products for children 6+ months of age and 1+ years of age were advertised in Dakar. Average air time for BMS advertisements was 189.5 min per month in Phnom Penh and 29.7 min in Dakar. Air time for CPCF advertisements averaged 3.2 min per month and 13.6 min, respectively. Fewer than half of BMS advertisements and three quarters of CPCF advertisements explicitly stated an age of use for products. Nutrition and health claims were common across BMS advertisements. This study illustrates the need to adopt, regulate, monitor, and enforce legislation prohibiting BMS promotion, as well as to implement regulations to prevent inappropriate promotion of CPCF. [ABSTRACT FROM AUTHOR]