April 2022

We hope you’ve all had a good month and enjoyed the Easter long weekend. This month we want to share with you highlights from two recent peer reviewed papers; one which reveals worrying data about the extent to which young children’s diets in the UK are dominated by ‘ultra-processed foods’ which are linked to rising rates of obesity among other negative health outcomes, and another which shows the pervasive problems of unfounded and inappropriate claims made on commercial baby foods (many of which are likely to be ultra-processed). In Infant Milk news we share with you a discontinued product, highlights from and implications of our updated infant milk cost report, and we unpack the evidence used in a new ad for the specialised infant formula Neocate Syneo. As secretariat of the Baby Feeding Law Group UK we share news of the launch today of a new WHO report on the digital marketing of breastmilk substitutes. And lastly, we share the details of two forthcoming events which might be of interest, find out more below.

New Papers

Ultra-processed food consumption and dietary nutrient profiles associated with obesity

Daniela Neri and colleagues published this paper in October 2021 examining ultraprocessed food (UPF) consumption in eight countries, stratified by age group, and including analysis of the UK National Diet and Nutrition Survey data from 2008-2014. It found that among UK children aged between 2 and 5 years old, close to two thirds (61%) of total mean energy intake came from UPFs. This compares to national estimates for the population aged 1.5 years and over from another study (by Rauber et al, 2018) of 1764 kcal/day average energy intake, of which 56.8% of calories comes from UPF. The Neri study indicated that among children aged between 2 and 5 years old, only 22% of kilocalories came from ‘unprocessed and minimally processed foods’ (on which diets should ideally be based), whilst ‘processed culinary ingredients’ contributed 3% of kilocalories and ‘processed foods’ contributed 4% of kilocalories (noting that these different food categories are from the NOVA classification). The contribution of UPFs to total energy intake of 2-5 year olds in the UK was the highest among all of the eight countries studied, and was higher than the estimated contributions of UPF to the total mean energy intakes for children aged 6-11 (at 57%) and adolescents (12-19) (at 55%).

At the moment there is little attention being paid to the extent to which UPFs dominate UK diets, despite consistent and mounting evidence around their negative health effects. This BBC documentary which aired last June provides an interesting overview of the problem (albeit without due attention to infants and young children) BBC One - What Are We Feeding Our Kids?. Watch this space for our forthcoming briefing note on ultra-processed foods in the diets of infants and young children in the UK.

Read the full paper by Neri et al, here.

Extensive use of on-pack promotional claims on commercial baby foods in the UK

Ada Garcia and colleagues published this paper in February 2022 exploring and categorising the nature of promotional claims on packaging of commercial baby foods for sale in the UK. A total of 6265 promotional claims were identified on 724 products. Marketing, composition and nutrient claims were found on between 99 and 85% of products, compared with health claims which were found on only 6% of products. Marketing claims were mainly texture (e.g. super smooth) and taste related (e.g. first tastes). The main composition claim was that the product was organic while nutrient claims were mainly around ‘no added’ or ‘less’ sugar and salt. Baby led weaning claims (e.g. encourages self-feeding) were found on 72% of snacks, with a significantly higher number of such claims on snacks compared with other product types.

The paper concludes that promotional claims on commercial baby food packaging are extensively used and, for the most part, unregulated. These products are being promoted using claims that act as ‘health halos’, highlighting the urgent need for regulatory action to stop inappropriate marketing.

As we have documented in our reports on commercially produced foods marketed for babies and in our report ‘Enabling children to be a healthy weight: What we need to do better in the first 1,000 days’, misleading marketing of food aimed at infants and young children is a critical issue that needs to be urgently addressed. The DHSC consultation on the labelling and marketing of baby foods is now long overdue, but apparently still forthcoming. This will provide an ideal opportunity to reiterate the recommendations of this useful study.

Read the full paper by Garcia et al, here.

Independent, evidence-based information and advice to support ‘eating well’ in infancy and for children aged one to five years of age, avoiding commercially produced (including ultra-processed) products, can be found on our website, here.

Infant Milk News

Discontinued products

While consumers are highly concerned and focused on the sustainability of the products they are using, most consumers are not looking for an Organic formula. Therefore, we have made the decision to focus our efforts on the continued journey to improve sustainability across all SMA products including the investment into plant-based plastic for our packaging, electricity made from renewable sources and working with farms to make net zero dairy farms a reality.’

The cost of most powdered infant milks has risen. Kendamil and Nannycare have not increased their prices, although Nannycare goats’ milk infant formula remains amongst the most expensive powdered infant formula milks. The cost of the least expensive powdered infant formula has risen from 10p to 12p per 100ml or from £6.44 to £7.73 per week for feeding a 2-3 month old baby, which translates into a weekly increase in cost of £1.29. For families using the most expensive brand of powdered non organic cows’ milk based infant formula, the weekly cost has risen from £16.10 to £17.39, a rise of £1.29 per week. Analysis of the ONS ‘Family Spending in the UK Survey April 2019 to March 2020’ (from an organisation called Nimblefins) suggests that households in the lowest 10% of incomes spend around £54 on food per week, which means an an increase of £1.29 in formula spend per week is huge when considered as just one item amongst many in the weekly shopping basket that will have risen in cost.

For those eligible for the Healthy Start scheme (or in Scotland Best Start Foods scheme), families with one infant receive a weekly healthy food allowance of £8.50 which is equivalent to 2x £4.25 healthy start vouchers. This can in theory cover the cost of a 900g can of the least expensive infant formula, however, this particular product is only available at one supermarket chain. In order to buy more readily available but slightly more expensive infant milks costing between £9.00 and £10.00, families would be required to find the additional 50p to £1.50 each week from their remaining income.

Ingredient-based claims: there is no ‘best’ infant formula

Marketing and advertising are known to have a significant influence on families’ choice of infant formula. Given the pressure on family food budgets, particularly for those on the lowest incomes, now would seem a good time for healthcare professionals to remind families they care for that all infant formulas in the UK must meet the regulations with regards to nutritional composition, meaning cost differences between products are not related to health or nutrition benefits, and, there is no ‘best formula’, regardless of what companies may claim on the basis of the ingredients they use.

Differences between formula brands are often related to non-essential ingredients that manufacturers have added, but which expert committees have decided lack evidence of benefit to infant health. In 2014, The European Food Safety Authority (EFSA), compiled a list of unnecessary ingredients which includes prebiotics (also called GOS and FOS), probiotics, nucleotides, phospholipids and some structured fat components and a number of other components that may be used by companies to make claims about the superiority of their product. We would add dairy fat in the form of whole cows’ milk or anhydrous milk fat, as well as human milk oligosaccharides (HMOs) to this list, as there is no convincing evidence of any clinical benefits of their inclusion in infant milks.

For more information see ‘Reviews of claims made for infant milks or ingredients’ .

New ad for the amino acid formula Neocate Syneo

Nutricia published a new advert in the March edition of Network Health Digest for their product Neocate Syneo, an amino acid formula containing synbiotics for use in infants with Cows’ Milk Allergy (CMA). The ad references new evidence to support claims that use of this product is associated with lower rates of infection, fewer gastrointestinal symptoms, reduced use of medication and a shorter time to resolution of CMA, as well as making cost saving claims.

The new evidence is a retrospective matched cohort study by Sorensen et al 2021 that uses real world data to confirm results of previous clinical trials (which we have previously reviewed here).The study was funded by Nutricia, the product manufacturer, and examined data from The Health Improvement Network database. 148 clinical records were included in the study, 74 from children prescribed AAF-Syn and 74 children prescribed AAF without pre- or probiotics, matched by age at diagnosis, sex and observation period. No breastfeeding reference group was included and the study did not report on other baseline characteristics such as complementary feeding, breastfeeding or other formula use. A proxy was used to measure disease severity and designation of children to a group was determined as the proportion of time a specific formula was used (switches between formula were expected during the course of the study).

The study showed AAF-Syn use to be associated with a 35% lower rate of infections; however, no significant difference in the proportion of infections was found between groups. The study also found 50% lower gastrointestinal symptoms in children prescribed AAF-Syn as compared to those prescribed AAF, but no children experienced a gastrointestinal infection in the AAF-Syn group, so symptoms could not be attributed to an infection in all cases. In addition, the study associated Neocate Syneo use with a reduction in medication of one fifth. Significant difference was shown between groups of children in rates of medication but not proportions of medication use.

The study claimed a 31% shorter clinical journey was achieved for children prescribed AAF-Syn as compared to AAF. The resolution of the course of symptoms was assumed when children had presented with no clinical symptoms for a consecutive period of three months and no hypoallergenic formula had been prescribed.

Finally, the claim of cost saving was based in-part on extrapolations of costs associated with appointments, specialist referrals and hospital admissions. However, no statistically significant difference between groups was found in these outcomes.

Taking into account the study methodology and small group sizes, we feel it is unlikely that the associations reported are attributable to the synbiotic containing formula. In our view, the use of proxy measurements and assumptions regarding baseline characteristics in each group make it impossible to make valid comparisons between groups. In addition, confounding factors such as significant differences in AAF consumption data and the impact of complementary feeding mean that any conclusions drawn should be viewed as tenuous associations.

Independent information on all the available formulas marketed in the UK for infants diagnosed with CMA can be found on our infant milks website, in our report on the specialised milks for infants with allergy, which is available here.

Looking for information about infant milks? Check out our website www.infantmilkinfo.org. Still got questions about infant milks? Contact susan@firststepsnutrition.org

Baby Feeding Law Group news

Launch of new WHO report on the scope and impact of digital marketing for the promotion of breast-milk substitutes

Today, Friday 29th April, the WHO are launching their latest report exposing the problem of inappropriate breastmilk substitute marketing, and this one focuses on the scope and impact of digital marketing. The report comprises a review of evidence about the digital marketing approaches used by the formula milk industry and the research has used a commercial social media intelligence gathering tool.

These new findings raise considerable concern about the use of powerful digital marketing techniques to reach mothers online and influence the decisions they make about feeding their babies. This is a concern we also raised in relation to UK digital marketing in 2020, in our report “Why government should end online infant formula marketing to protect children from overweight”.

In this report we said:

“Online marketing of infant milks targets young women, provides no beneficial information (since there are regulations that control infant formula composition that all companies must abide by) and undermines messages from health professionals. Influencers and celebrities promote products and lifestyles that young women may aspire to and pop-ups and links to websites, blogs, vlogs and other social media content create an online world which undermines Government and health worker efforts to protect breastfeeding and protect families from spending money than they need to on more expensive formula brands. To help prevent obesity and to protect the health of mums and babies, online marketing of all infant milks marketed for children under 3 years of age should be totally restricted in the UK at the same time as a total online marketing restriction for high fat, salt and sugar foods”.

Given the unprecedent high rates of childhood obesity captured by the 2020/21 National Childhood Measurement Programme (and reported on in our November newsletter) and the current cost of living crisis, this issue remains as pertinent as ever.

Find out more about the WHO’s new report here and sign up to the petition to #EndExploitativeMarketing

Forthcoming

Launch of the “Mothers’ Milk Tool”: May 5th 2022

Julie Smith and colleagues at the Australian National University and Alive & Thrive Southeast Asia are launching this new “Mothers’ Milk Tool” on May 5th. The objective of the tool is to better enable breastfeeding and mothers’ milk to be counted in analyses of food systems and national economies.

The team state: “Money is the language of policymakers. Counting human milk production in food and economic statistics will assist in better policy decision-making and investments in women’s unpaid care work. The Mothers’ Milk Tool quantifies the volume of breastmilk and value of breastfeeding at national and global levels, as well as how much is lost if country environments and policies, or healthcare, work and community settings do not enable women’s and children’s rights to breastfeeding”.

Given the absence of anything about babies in the Independent Review for the National Food Strategy (as outlined in this policy brief), we will be doing our best to share this message with the relevant people ahead of the promised release of the White Paper, which latest intelligence suggests will be after the Queen’s speech in mid-May.

You can register for the Mothers’ Milk Tool launch webinar which is taking place on Thursday 5 May 2022, 6-8 pm Sydney time (AEST) here.

UNICEF Baby Friendly conference November 23rd-24th 2022

Booking is now open for this year’s Baby Friendly Annual Conference (Virtual) which will take place over two days, the 23rd and 24th of November 2022. There will be in-depth updates on recent research and innovations related to infant feeding and relationship building, live Q&As and virtual posters. Interactive new networking opportunities will also be made available so delegates can catch up between talks and after the conference. UNICEF will be announcing the speaker line-up and more details in due course.

There is a discount for signing up before the end of August and for group bookings of 10 or more. Booking closes at 5pm on November 18th.

Find out more and book tickets for the UNICEF Baby friendly 2022 conference here.