Health and nutrition claims for infant formula: international cross sectional survey

Abstract

ObjectivesTo review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims.DesignInternational cross sectional survey.SettingPublic facing and healthcare professional facing company owned or company managed formula industry websites providing information about products marketed for healthy infants delivered at full term in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States in 2020-22.Main outcome measuresNumber and type of claims made for each product and ingredient. References cited were reviewed and risk of bias was assessed for registered clinical trials using the Cochrane risk of bias tool, and for systematic reviews using the Risk Of Bias in Systematic reviews tool.Results757 infant formula products were identified, each with a median of two claims (range from 1 (Australia) to 4 (US)), and 31 types of claims across all products. Of 608 products with ≥1 claims, the most common claim types were “helps/supports development of brain and/or eyes and/or nervous system” (323 (53%) products, 13 ingredients), “strengthens/supports a healthy immune system” (239 (39%) products, 12 ingredients), and “helps/supports growth and development” (224 (37%) products, 20 ingredients). 41 groups of ingredients were associated with ≥1claims, but many claims were made without reference to a specific ingredient (307 (50%) products). The most common groups of ingredients cited in claims were long chain polyunsaturated fatty acids (278 (46%) products, 9 different claims); prebiotics, probiotics, or synbiotics (225 (37%) products, 19 claims); and hydrolysed protein (120 (20%) products, 9 claims). 161/608 (26%) products with ≥1 claims provided a scientific reference to support the claim—266 unique references were cited for 24 different claim types for 161 products. The reference types most frequently cited were clinical trials (50%, 134/266) and reviews (20%, 52/266). 28% (38/134) of referenced clinical trials were registered, 14% (19/134) prospectively. 58 claims referred to 32 registered clinical trials, of which 51 claims (27 trials) related to a randomised comparison. 46 of 51 claims (90%) referenced registered clinical trial outcomes at high risk of bias, and all cited systematic reviews and pooled analyses, carried a high risk of bias.ConclusionsMost infant formula products had at least one health and nutrition claim. Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.

High Rates of International Code Violations: A Cross Sectional Study in one Region of Canada with Low Breastfeeding Rates

“…It is common for health and nutrition claims to appear on commercial milk infant formula products and promotional materials despite the many national regulations and international guidance prohibiting this type of marketing [27]. These claims are found on the packaging and promotional websites across all countries regardless of their compliance with the IC [27].…”

“…It is common for health and nutrition claims to appear on commercial milk infant formula products and promotional materials despite the many national regulations and international guidance prohibiting this type of marketing [27]. These claims are found on the packaging and promotional websites across all countries regardless of their compliance with the IC [27]. Authors suggest that the global regulatory and public health communities, governments, and public policy civil servants are failing to effectively limit the use of claims in the marketing of commercial milk infant formula [27].…”

“…These claims are found on the packaging and promotional websites across all countries regardless of their compliance with the IC [27]. Authors suggest that the global regulatory and public health communities, governments, and public policy civil servants are failing to effectively limit the use of claims in the marketing of commercial milk infant formula [27].…”

A long-acting prolactin to combat lactation insufficiency

“…These emergencies disproportionally impact marginalized communities globally. They have borne most of the intersecting burdens of climate change, systemic and structural racism, racial healthcare disparities, and inadequate lactation support 1,17,48,[72][73][74][75][76] . We hope our Prolactin-XL can be an everyday bolster for breastfeeding and stockpiled for emergency situations, like vaccines and essential medicines.…”

Marketing and child feeding

“… 17 The fact that there is no transparency and simplified dissemination of this information, lead doctors to have little knowledge about the potential risks involved in the consumption of these products, which can compromise the quality of the medical procedure and the safety of children. 30 Promotional information, attributing greater or better functionality to the consumption of processed baby foods, is one of the strategies most frequently used by marketing ( Table 1 ). A recent study that analyzed the reliability of health claims propagated by infant formula industries in 15 countries, proved the inconsistency of several claims, having found that the same beneficial effect was attributed to different types of ingredients, and conversely, different benefits were attributed to the same ingredient.…”