Welcome to our March news update. We hope you are enjoying the lighter evenings since the clocks went forward.

Before we get on to news, once again we’d like to highlight that we have a surplus of our “Eating Well: Packed lunches for 1-4 year olds”. We would be happy to send a free bulk order to any early years settings or public health organisations that could put them to good use, we’d only ask for postage to be covered. Please email admin@firststepsnutrition.org if you are interested.

This month we share with you: reflections on two new studies on preventing food allergy through the early introduction of potentially allergenic foods; news on the tightening of EU (but not UK) laws on arsenic in baby foods and on the use of titanium dioxide as a food additive; and lastly information on a range of new work on food insecurity and recommendations to mitigate its effects on infants and young children.

As secretariat of the BFLG-UK, we share with you a new infographic of our report ‘Infant milks marketed as Foods for Special Medical Purposes: A case for regulatory reform to protect infant health’.

For forthcoming events, City University is holding its annual Food Policy symposium on April the 27th and Sustain’s Children’s Food Campaign are holding their first ever summit in Leeds on May 16th. We’ll be at both so please come and say hello. Also, please look out for the first in a series of short surveys we’ll be sending to you, our key audience, over the coming months, with the aim to evaluate our communications and resources and their usefulness to you

Lastly, we’ll be very sad to say goodbye to Siân next week, but are delighted to introduce you to Priscilla who will be stepping in to the administrator role.
 

Happy reading!

News

Preventing food allergy through early introduction of potentially allergenic foods

Two recent papers explore the allergy-prevention effects of introduction of certain potentially allergenic foods before 6 months of age, challenging current public health guidance. Allergenic foods include milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soya, but the most widely studied to date are egg and peanut. Here we critique both papers and implications for practice. It should be noted that there is a great deal of conflict of interest in this field of research with respect to the food industries that stand to gain from any change in current recommendations.

‘Defining the window of opportunity and target populations to prevent peanut allergy’ by Roberts et al, 2022

The researcher’s recommendation that infants with eczema (especially severe eczema) are introduced to peanut from 4 months is more straightforward. However, it should be noted that the data presented in the scenarios does not provide evidence for benefit of reducing the age of introduction of peanut for infants with eczema from the existing public health recommendation of ‘around 6 months’ to ‘from 4 months’. Current relevant NHS advice is as follows ‘If your baby already has a diagnosed food allergy or eczema, or if you have a family history of food allergies, eczema, asthma or hay fever, you may need to be particularly careful when introducing foods, so talk to your GP or health visitor first’. In their 2018 report ‘Feeding in the First Year of Life’ SACN state ‘Families of infants with a history of early-onset eczema or suspected food allergy may wish to seek medical advice before introducing these foods’. The only available clinical guidance, from BSACI, promotes introduction from four months for infants with severe eczema and high allergy risk under clinical supervision. However, it should be noted that this has not been endorsed by any independent national bodies such as NICE.

In addition, it is important to remember that the study itself is a data modelling exercise and makes a number of assumptions, including that allergy prevalence will be the same at 3 years of age as at 5 years, that there is no allergy protection associated with breastfeeding and that intervention compliance would be good, a fact not reflected in the initial EAT study (plus see more on this critical point in the second study, below). There are also weaknesses associated with merging different datasets and it is unclear whether this data is based on introducing peanut products only where readiness for solids has been established. Also noteworthy is the potential conflict of interest present in the original clinical trials: the LEAP trial received some grant funding from the National Peanut Board and one of the authors has received grant support from Meridian foods who make peanut products, and in the EAT study, one of the authors received grant funding from the National Peanut Board.

The most recent UK data on infant feeding from 2010 reported that only 8% of UK infants had eaten any peanut or peanut products by 8-10 months. In terms of practical actions on the basis of this study in the context of the current public health recommendations, this suggests that more could be done to encourage parents/carers to include peanuts (crushed or ground) among the first foods given to infants when they start complementary feeding at around 6 months.

The full paper can be access here.

‘Timing of Allergenic Food Introduction and Risk of Immunoglobulin E–Mediated Food Allergy: A Systematic Review and Meta-analysis’ by Scarpone et al, 2023

On Monday this week, Scarpone et al published this updated systematic review and meta-analysis examining the timing of allergenic food introduction and risk of Ig-E mediated food allergy (i.e. allergy involving reaction within minutes of eating the food, including itchy rashes, swelling of lips/face/skin around eye) as well as anaphylaxis; read more here).

The stated background to this paper is that, at a public health level, ‘earlier’ egg and peanut introduction probably reduces the risk of egg and peanut allergy respectively, but it is uncertain whether food allergy as a whole can be prevented using ‘earlier’ allergenic food introduction (where ‘early’ is defined differently in different studies, but spans the period under 6 months of age). The authors highlight that this question is important because prevention of 1 or 2 specific food allergies only may have limited public health impact, and, for infants and their caregivers, prevention of any food allergy is likely to be the more important goal.

This study found that earlier introduction of multiple allergenic foods was associated with reduced IgE-mediated allergy to any food; that earlier egg and peanut introduction were associated with lower risk of egg and peanut allergy respectively; but also – importantly - that early introduction interventions can be hard to adhere to. Two large pragmatic multiple allergenic food introduction trials reported low adherence to interventions involving stepwise introduction of foods, due to reported feeding difficulties. Whilst three smaller studies used multiple allergenic food protein powders and had lower rates of withdrawal. The authors recommend that wider issues around the nutritional composition, texture, flavour and marketing of commercial foods for infants need to be considered before making recommendations to use commercial multiple allergenic food protein powders for food allergy prevention.

The authors also highlight that interventions involving the introduction of foods before 6 months of age contravene WHO [and UK public health] infant feeding recommendations on exclusive breastfeeding, and that effects on general child health and development are unclear and may be harmful in low and middle income countries.

The findings support the concept of using earlier allergenic food introduction to prevent food allergy, but highlight the need to develop allergenic food interventions that are safe and acceptable for infants and their families.

As above, the conflict of interest inherent in this study given its data sources means that its findings and recommendations need to be assessed with due caution.

The full paper can be accessed here.

EU regulatory changes limiting arsenic in baby foods and banning the use of titanium dioxide as a food additive, will not be reflected in UK food standards

Limiting organic arsenic in rice based foods, including baby foods

Inorganic arsenic, which is the form of arsenic that poses a risk to health, occurs naturally in the environment and is therefore present in the food we eat. Long term exposure to high levels of arsenic causes skin lesions and may be a precursor to skin cancer (WHO, 2018). Although it can’t be eliminated from food and we are all exposed to it to some degree, the concentration of arsenic in rice-based foods is regulated. Current UK regulations are based on the retained EU regulations introduced in January 2016 which define maximum concentrations permissible in rice and rice-based products.

Banning the use of titanium dioxide as a food additive (E171)

Titanium dioxide (TiO2) is widely used in foods such as cakes, pastries, confectionery and food supplements to give them a white colour, some of which may be eaten by young children. It is not permitted in foods and drinks marketed for infants and young children under (EC) No 1333/2008 of the retained EU legislation. In 2022, as a result of research carried out by EFSA, its wider use as an additive in foods was banned in the EU on the basis of potential genotoxicity. In the UK, the EFSA evidence was reviewed by COT (the Committee on the Toxicity of Chemicals in Food, Consumer Products and the Environment) and COM (the Committee on the Mutagenicity of Chemicals in Food, Consumer Products and the Environment) who did not agree with the EU position banning its use as a food additive. The Food Standards Agency and Food Standards Scotland are in the process of undertaking their own risk assessment which is meant to report in the first quarter of 2023.

What does this mean for food standards in the UK?

These changes to the EU regulations are not influencing changes in UK regulations as they might have done prior to Brexit. The UK’s food regulations are based on the EU regulations as they were when the UK left the EU. Under the Northern Ireland Protocol, foods produced in Northern Ireland destined for the UK or Europe must comply with EU regulations. However, foods produced in Great Britain and imported into Northern Ireland may, under the conditions of the Windsor Framework, continue to be manufactured in adherence to UK safety standards. In theory this means that baby foods produced in Great Britain where regulations permit higher arsenic residues, and general foods produced in Great Britain where titanium dioxide remains a permissible food additive, will still be eligible for sale in Northern Ireland as well as in Great Britain.

In practice, however, the threat of the higher permissible limits on arsenic in baby foods in the UK is lessened by the fact that most baby food is imported from Europe (and in our November 2022 newsletter we provide guidance on how to safely approach rice and rice-based products in the diets of infants and young children). As no baby foods are allowed to contain titanium dioxide, the different regulations between the EU and UK on titanium dioxide as a food additive in food more generally is perhaps more of a concern, given the transition to family foods that starts in infancy. We await the recommendations of the FSA and FSS. The main purpose of reporting on these cases of regulatory change and discrepancy between the UK and the EU, is to highlight the concerning precedent they set with respect to food safety for our youngest citizens. This is a matter which we will be undertaking advocacy on in the year ahead.

Rising rates of food insecurity: the latest recommendations and initiatives

The Food Foundation continue through their monitoring, to draw attention to high and rising rates of food insecurity. Food prices continue to rise, and consumer price inflation for foods is higher than general inflation (see graph). This means that the cost of the food basket the Food Foundation is monitoring has risen by 20-25% since April 2022.

It is not surprising therefore, that the Food Foundation have also reported that the number of households where children are experiencing food insecurity has nearly doubled in the past year (from 21.6% of household with children in January 2023 compared to 11.6% in January 2022), demonstrating the need for urgent policy action to ensure children can access the food they need. Households report switching to lower cost foods (which are more likely to be unhealthy) and less often but with a worrying increase in frequency, skipping meals altogether.

In this context and given the important gaps in the Spring budget (notably NOT including any improvements to the Healthy Start scheme), we remain deeply concerned about the likely negative effects on infants and young children. Below are some welcome relevant initiatives.

The Food Foundation’s Cost of Living briefing and Kids Food Guarantee

In March the Food Foundation and City University published a new briefing highlighting how the cost of living crisis will be negatively affecting UK diets, with particularly serious long term health consequences for low-income families.

Drawing on ongoing research they outline 5 pathways driving families towards making “unhealthy dietary decisions” (i.e. those which prioritise high fat, salt and sugar foods/drinks and ultra-processed foods/drinks) during times of crisis:

IFAN-UK Scotland briefing

In February, the Independent Food Aid Network (IFAN) ran a survey of its member organisations across the UK to track demand and their capacity to cope with increasing need. Additional questions related to supporting parents/carers struggling to feed infants were included. In March they reported their results for Scotland here, which come from 17 contributing organisations running 30 independent food banks in 16 local authorities.

Among the findings:

·         A third of these surveyed organisations reported that more parents/carers had asked for their support to feed their babies from December 2022 to January 2023 compared to the same two-month period a year ago.

·         The most common route of referral was self-referral, followed by referral through a health practitioner.

·         41% of contributing organisations were not aware of any local authority guidance on how to support food insecure families with babies (noting that available guidance is available here: Supporting families with infants in food insecurity - Baby Friendly Initiative (unicef.org.uk)[VS1] [PM2] 

·         Organisations reported supporting families most commonly through purchasing the required infant formula, and less commonly through the provision of donated formula from the food bank or providing vouchers for the purchase of formula.

The briefing highlights that the current cost-of-living crisis, on top of pre-existing poverty, is putting increasing pressure on parents/carers to be able to feed their babies, as well as independent food banks’ capacity. It states that the provision of charitable food aid is not an effective or sustainable response to the growing food insecurity experienced by many parents/carers with babies and young children and highlights the urgent need to embed a cash first approach.

We back IFAN’s call on the UK Government to take immediate action to increase social security payments to levels that match the cost of living. And we agree that it is vital that fair wages and job security become the norm.

We are pleased that IFAN supports our recommendations for the Government (Defra) to address the fairness of infant formula pricing, including the price differentials between products and the rise in cost beyond general food inflation.

The Scottish Government are taking some steps which will improve vulnerable young families access to food, which we hope the UK Government will consider.  These include increasing the Best Start Foods payment. However more action is urgently needed. See the briefing here for full recommendations.

We will share the UK-wide data when this is available.

Policy insight: How secure is our infants’ food supply? Why the Government’s food security assessment must include breastfeeding and infant formula in the supply chain

Baby Feeding Law Group UK news

New infographic: Infant milks marketed as Foods for Special Medical Purposes (iFSMPs)

Forthcoming

Taking stock

We are working on an evaluation of our current communications and resources and their uses/usefulness in order to improve what we do and better support you, our key audience, in providing evidence-based, independent advice to support healthy eating from preconception to five years. As part of this evaluation, over the next few months we’ll be sending out a number of short surveys to collect your valuable feedback. If you are signed up to our mailing list, please look out for the first survey in your inbox next week!

The 2023 City Food Policy Symposium: April 27th, London

This year’s symposium is: From trade-offs to co-benefits in times of crisis: finding positive food policy solutions to multiple food system challenges. It will address policymaking in times of many overlapping crises — climate, biodiversity, food insecurity, malnutrition, inequality and more — with systemic solutions. We will be making sure infants and young children are not forgotten in the discussions, and hope to see you there. You can book a place here.

Children’s Food Summit: May 16th, Leeds

HR Update

Welcome Priscilla!