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Purpose: We designed and evaluated food-based dietary recommendations for 12-24-mo-old New Zealand children with linear and goal programming models taking into account intakes of all nutrients concurrently. Methods: Dietary data used to define model parameters (food list, food quantities consumed, and food consumption patterns from 3-d weighed food records) were collected from 12-24-mo-old New Zealand toddlers (n = 188). Linear and goal programming models were developed to design and evaluate three sets of recommendations: (1) using all foods consumed by toddlers; (2) excluding commercial infant/toddler foods; and (3) excluding both commercial infant/toddler foods and all iron-fortified foods. Results: Food-based dietary recommendations for toddlers were developed which aligned with observed food consumption patterns: Non-Sweet Cereals: 3 serves/d, Vegetables: 2 serves/d, Fruit: 2 serves/d, Dairy: 2 serves/d, and Meat/Fish/Poultry/Eggs/Legumes/Nuts: 2 serves/d. However, they only ensured adequate intakes of all nutrients modeled if ≈ 500 g/d of iron-fortified toddler milk was also recommended. Food-based dietary recommendations that excluded commercial infant/toddler foods or excluded both commercial infant/toddler foods and all iron-fortified foods would not ensure adequate intakes of iron and folate, for all children. The lowest intakes, in simulated intake distributions for these nutrients, were ≤ 29% and ≤ 38% of their nutrient reference values, respectively. Conclusions: Food-based dietary recommendations which successfully promote the consumption of 3 serves/d of Non-Sweet Cereals, 2 serves/d of Vegetables, 2 serves/d of Fruit, 2 serves/d of Dairy (including ≈ 500 g/d of iron-fortified toddler milk), and 2 serves/d of Meat/Fish/Poultry/Eggs/Legumes/Nuts should ensure all New Zealand toddlers meet their requirements for the 15 nutrients modeled. [ABSTRACT FROM AUTHOR]

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.

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. Key messages: The amount of publications about CMF 12–36 has been growing since the late 1980s, with a marked increase in the last decade.CMF 12–36 are often not framed as breast milk substitutes, although there is international consensus that they should be.Several terms are currently used to refer to CMF 12–36, some of which are unclear or misleading. To allow for standardized communication, "drink for young children", as proposed by the new 2023 Codex standard, is an acceptable name.CMF‐industry involvement by means of material and financial support is common and not always clearly reported. Ties to the CMF‐industry should always be disclosed as "conflicts of interest". [ABSTRACT FROM AUTHOR]

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.

'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]

Assess milk type provision (commercially prepared infant and toddler formula, cow's milk, and plant milk) to infants and toddlers, accounting for sociodemographic characteristics and marketing claims. Caregivers (N = 1,645) of children (aged 6–36 months) recruited through online panels in 2017. Cross-sectional survey analysis (system of probit equations) estimated associations between sociodemographics and agreement with marketing claims (independent variables) with milk type provision in the past month (binary dependent variable). Most caregivers (63%) of infants (aged 6–11 months) provided only breastmilk and/or commercially prepared infant formula. Sixty-five percent of caregivers of 12-month-old infants provided commercially prepared infant formula, and 47% provided cow's milk. Most caregivers (64%) of toddlers (aged 13–36 months) provided cow's milk; some also provided other non-recommended milk types (51%).Associations between milk types suggested milk-based drink provision should be evaluated as a pattern and not as independent behaviors (all P s < 0.048). Milk type provision was significantly associated with a child's age (months), household income, and race (all P s < 0.049). Including agreement with marketing claims reduced the significance of associations between milk type provision and some sociodemographic characteristics. These findings suggest the need for additional expert guidance to discourage inappropriate and unnecessary milk for young children, provide strategies to transition from breastmilk (or commercially prepared infant formula) to cow's milk, and conduct outreach to communities at risk for health disparities about the dangers of serving milk that is not recommended for their child's age. Research is needed to understand how diverse populations interpret product claims and how marketing may perpetuate health disparities. [ABSTRACT FROM AUTHOR]

The World Health Organization International Code of Marketing of Breast‐milk Substitutes prohibits claims and other marketing that may confuse caregivers about benefits of formula and other milk‐based drinks for infants and toddlers, but such marketing is common in the United States. This study assessed caregivers' provision of milk‐based products to their infants and toddlers and potential confusion about product benefits and appropriate use. Online survey of 1,645 U.S. caregivers of infants (6–11 months) and toddlers (12–36 months). Respondents identified infant formula and toddler milk products they served their child (ren) and provided relative agreement with common marketing claims. Logistic regression assessed relationships between agreement and serving these products, controlling for individual characteristics. Over one‐half of caregivers of infants (52%) agreed that infant formula can be better for babies' digestion and brain development than breastmilk, and 62% agreed it can provide nutrition not present in breastmilk. Most caregivers of toddlers (60%) agreed that toddler milks provide nutrition toddlers do not get from other foods. Some caregivers of infants (11%) reported serving toddler milk to their child most often. Agreement with marketing claims increased the odds of serving infant formula and/or toddler milks. For caregivers of toddlers, odds were higher for college‐educated and lower for non‐Hispanic White caregivers. Common marketing messages promoting infant formula and toddler milks may mislead caregivers about benefits and appropriateness of serving to young children. These findings support calls for public health policies and increased regulation of infant formula and toddler milks. [ABSTRACT FROM AUTHOR]

Toddler milk products are ultraprocessed milk-based beverages promoted for children aged 9 through 36 months. They often contain added sugars, which may contribute to unhealthy dietary habits. Aggressive promotion of toddler milk, particularly to the Latinx population, has likely led to rapid rises in sales. The study aims were to qualitatively explore caregivers' experiences with, beliefs about, and attitudes toward toddler milk; to explore caregivers' reactions to health claims and product warnings on toddler milk packaging; and explore whether perceptions of toddler milk differ by Latinx ethnicity. Focus group discussions and in-depth interviews were conducted. Fifteen online in-depth interviews and 4 online focus groups with US caregivers of children aged 9 through 36 months who reported serving toddler milk to their children were conducted in 2021. Audio files were transcribed, coded, and analyzed in NVivo. A thematic analysis with a hybrid analytical approach of deductive and inductive coding was conducted. Caregivers struggled to discern toddler milk from infant formula and perceived formula as a larger term that included toddler milk. Participants described offering toddler milk to their children for its convenience, nutritional profile, and perceived benefits tied to health claims present on the labels. Participants reported that health claims on toddler milk packaging attracted their attention; most participants did not express skepticism about the veracity of the claims. An "added sugar" warning increased understanding of the presence of added sugar in a toddler milk product. Latinx and non-Latinx participants largely reported similar perceptions, beliefs, and patterns of provision of toddler milk. Health claims may lead caregivers to perceive toddler milk as a nutritionally adequate product. Research is needed to investigate caregiver-directed interventions for informing caregivers about the distinction between infant formula and toddler milk. [ABSTRACT FROM AUTHOR]

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There has been a prolonged increase in the sale and consumption of ultra-processed, discretionary foods and ultra-processed milks for toddlers, which display numerous on-pack claims that influence health perceptions. This study investigated the relative impact of different regulated and unregulated claims on parent perceptions of the healthiness of a toddler snack food and milk in Australia. Participants aged 18+ years completed an online survey, including discrete choice experiments for an ultra-processed, discretionary toddler snack food and an ultra-processed toddler milk, which displayed combinations of claims across nutrition, health, and other domains. Participants were asked to choose the 'most and least healthy' products between three alternatives over seven choice sets. Data were analysed using an ordinal logistic regression model. Likelihood-ratio tests revealed the most important contribution was variation in regulated nutrition-content claims. For the toddler snack, participants were nearly 14 times more likely to perceive a product with the regulated nutrition-content claim "no added sugar, no added salt" as most healthy (OR 13.71, p < 0.001), compared to when no regulated nutrition-content claim was present. For the toddler milk, participants were more than two and a half times more likely to choose a product that contained the regulated nutrition-content claim "2 serves = up to 50% of RDI recommended dietary intake of 14 vitamins and minerals" as most healthy (OR 2.65, p < 0.001) compared to when no regulated nutrition-content claim was present. In Australia, regulated nutrition-content claims can be displayed on packaged foods regardless of healthiness. These results indicate that such claims increase perceptions of healthiness of ultra-processed, discretionary toddler snack foods and ultra-processed toddler milks. Further controls are required to regulate the use of nutrition-content and health claims to facilitate informed consumer choice. [ABSTRACT FROM AUTHOR]

Although the advertising of infant and follow-on formula products in Australia is prohibited by the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement (1992), toddler milk is advertised without restriction. Recent research suggests that Australian mothers perceive advertisements for toddler milk to also be advertisements for infant formula. Furthermore, they tend to accept the messages they encounter in these advertisements uncritically. This study used established qualitative market research strategies to investigate what mothers, and those who influence mothers, know about formula milk products. This included exploration of commonly used sources of information, how toddler milk advertisements are interpreted and how the claims made in these advertisements are evaluated. Eight interviews were conducted: two individual interviews (involving a General Practitioner and a Community Dietitian) and six discussion groups (two groups of two mothers, two groups of two grandmothers, one group of two Child and Family Health Nurses and one group of five Child and Family Health Nurses). The results suggest that mothers seek advice about formula milk products from health professionals, their friends and their own mothers. The responses also suggest that all of these groups understand toddler milk advertisements to be advertising formula milk products and tend to rely on the messages contained in them to inform their decisions or advice about infant feeding products. It may therefore be difficult for mothers to access independent information upon which to base their decisions about infant feeding products. Further research is needed on whether sufficient independent information about infant feeding products is available to health professionals and mothers. [ABSTRACT FROM AUTHOR]

Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading. This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product. This was a 3-arm between-subjects randomized experiment. A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey. Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim). Outcomes included perceptions, intentions, and beliefs about the toddler milk product. Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P <.001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P <.001). These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging. [ABSTRACT FROM AUTHOR]

Protein intake in early life influences metabolism, weight gain, and later obesity risk. As such, a better understanding of the effects of protein intake on the postprandial metabolism and its dynamics over time may elucidate underlying mechanisms. In a randomized crossover study, we observed fasted adults who consumed two isocaloric toddler milk formulas concentrated as meals of 480 kcal with 67 g of carbohydrates 30 g (HP) or 7 g (LP) protein, and 10 g or 20 g fat, respectively. Anthropometry and body plethysmography were assessed, and blood samples collected at baseline and over five hours. Time-specific concentrations, areas under concentration curves (AUC), and maximum values of metabolites were compared by paired t-tests to examine the effects of protein content of toddler milks on postprandial plasma concentrations of insulin, glucose, branched-chain amino acids (BCAA), urea and triglycerides. Twenty-seven men and women aged 26.7 ± 5.0 years (BMI: 22.2 ± 2.5 kg/m2) (mean ± SD) participated. BCAA AUC, and Cmax values were significantly higher with HP than LP (144,765 ± 21,221 vs. 97,089 ± 14,650 µmol·min/L, p < 0.001; 656 ± 120 vs. 407 ± 66 µmol/L, p < 0.001), as were insulin AUC and Cmax values (6674 ± 3013 vs. 5600 ± 2423 µmol·min/L, p = 0.005; 71 ± 37 vs. 55 ± 28 µmol/L, p = 0.001). Higher glucose, urea, and triglyceride concentrations occurred in the late postprandial phase (≥180 min) with HP. In conclusion, we noted that higher milk protein intake induces increased postprandial BCAA concentrations for at least 5 h and led to higher initial insulin secretion. Gluconeogenesis due to an influx of amino acids and their degradation after HP meal might explain the late effects of protein intake on glucose and insulin. [ABSTRACT FROM AUTHOR]