Two new reports from the World Health Organisation (WHO) have found evidence of poor nutritional quality and misleading promotion of foods for infants and children under the age of 36 months. The findings run against WHO recommendations and challenge stakeholders to improve the way recommendations and guidelines on child health are implemented in EU member states and other countries.
The main findings showed that about a third of products listed sugar, concentrated fruit juices and other sweeting agents as ingredients in baby food. Around half of all sampled products had more than 30 % calories from total sugar, including naturally occurring sugars in fruit and vegetables.
WHO recommends that added sugar should be forbidden in all baby foods and total sugar should be limited to 15 % of energy intake. Infants under the age of half a year should preferably be breastfed and baby foods complements given only after that age.
As regards marketing of baby food, almost all products carry nutrition declarations – which of course is positive – but the labelling often includes health statements that can mislead parents or exaggerate the real content of primary food ingredients.
Even worse, between 10% and 60 % of the products, depending on location, were marketed as suitable for infants under the age of 6 months, running against the WHO guidance and undermining breastfeeding. While there is no advantage in starting with complementary food as early as 4 months, infants do need more nutrients after the age of half a year.
“Foods for infants and young children are expected to comply with various established nutrition and compositional recommendations. Nonetheless, there are concerns that many products may still be too high in sugars,” said Dr Joao Breda, Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases, at a seminar in Brussels (15 July).
The reports cover the WHO European Region, which consists of 53 countries, and are based on studies of the nutritional composition of baby foods in four cities and further information on nutrition quality and labelling in 13 countries.
“We cannot claim that the reports are representative of the entire EU and WHO/Europe market,” Joao Breda told the Brussels Times,“ but they are significative of the situation in the region and very consistent with other studies.”
WHO underlines that good nutrition in infancy and early childhood is key to prevent obesity and diet-related non-communicable diseases (NCD). Figures on obesity from 2017 show rates exceeding 10 % among boys in most countries, with the highest rates recorded in Cyprus, Spain, Greece and Italy (around 20 %). In most countries the rates are higher among boys than girls without any clear explanation.
“We can’t determine if there is a correlation between obesity rates and the availability of quality baby food products in different countries,” says Joao Breda. But his advice to the baby food industry and regulators in Europe is clear:
“You only have to take three small steps to improve the situation: Ban added sugar in baby foods altogether, limit the total amount of sugar and regulate the marketing of baby foods so it complies with WHO recommendations.”
If a baby only eats sugared products occasionally, does it matter if they contain too much sugar or other undesirable ingredients?
“I can agree with that,” Breda replied, “but still we must increase the quality of the products because there are parents who might use them too often. Sugar is relatively cheap and easy to obtain by the food industry. We can ensure a level playing field by limiting the amount of sugar in baby foods via regulation.”
He explains that naturally-occurring sugars in fruit purees can be considered free sugars and not so healthy due the high level of processing which releases sugars from the cell walls. Early exposure to sweet products may promote a preference for such foods.
Another crucial issue is breastfeeding, an issue which will be highlighted during the World Breastfeeding Week in beginning of August.
In a recent study, breastfeeding is described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. A global recommendation by WHO sets the target of exclusive breastfeeding in the first 6 months to at least 50% by 2025.
In reality, rates of breastfeeding vary considerably by country. Exclusive breastfeeding rates decline considerably after 4 months and are low in infants under and at 6 months of age. Figures were not always comparable but based on data from 24 countries they showed that the minimum and maximum prevalence of exclusive breastfeeding under 6 months varied between 2 % and 56 %.
Is breast feeding in EU countries less common than in non- EU countries? Breda, who was one of the co-writers of the breastfeeding study, says that breastfeeding is relatively low especially in the Western world with some exceptions. There is no single explanation but certainly there is a mixture of economic and cultural reasons.
A number of factors influence the prevalence of breastfeeding, such as a supportive environment, counselling, maternity leave, attitudes and behaviours towards breastfeeding (including hospitals, particularly maternities) as well as marketing pressures around formula (breastmilk substitutes).
Joao Breda believes that existing regulations normally are respected and enforced by EU member states but that some binding rules might still be lacking. The concentration and competition in the baby food market was outside the scope of the WHO studies.
The European Commission cannot be blamed, he said in Brussels, as member states are responsible for health issues, including baby foods. He hopes that the WHO reports will be used as an input to a broad discussion in member states and to inform on-going regulatory work.
EU regulatory work
Asked by The Brussels Times about the state of play, a spokesperson of the Commission replied that the composition and labelling of baby foods in EU are regulated in a directive but that the member states hold primary responsibility for the implementation and for overall health issues. Currently, the directive allows a considerable amount of energy, sometimes even 30%, from sugar in baby food.
“Reducing added sugars, as well as salt and saturated fat, in food products is one of the main priorities of the High-Level Group on Nutrition and Physical Activity (national experts) and the EU Platform for action on Diet, Physical Activity and Health,” says the spokesperson.
An Added Sugars Annex was adopted by the High Level Group in December 2015 calling for a 10% reduction of added sugars in processed foods by 2020. According to the Commission, some of the major food producers have committed to do this.
A sign that improvement is on its way is an upcoming delegated act on baby foods. (Delegated acts are adopted by the Commission as supplements to existing EU law.) One of the objectives of the future act is to reduce the sugar content in baby food products. The appropriate age of introduction of such foods in the diet of infants will also be considered.
Another measure in the pipeline is an evaluation of labelling guidelines for food products, including baby products. The European Food Safety Authority (EFSA) will also later this summer publish an opinion on the appropriate age range of introduction of complementary foods into infant diet. The opinion will be discussed with the member states with a view to adopt a delegated act.
The Brussels Times