Baby Care Products Information Diet and Nutrition Product

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Open Access

Peer-reviewed

Enquiry Commodity

Food claims and nutrition facts of commercial infant foods

• Yu-Chin Koo,
• Jung-Su Chang,
• Yi Chun Chen

x

• Published: February 28, 2018
• https://doi.org/10.1371/journal.pone.0191982

Figures

Abstract

Limerick claim, nutrition claim and wellness claim are often establish on the commercial complementary food packaging. The introduction of complementary foods (CFs) to infants is a turning point in the development of their eating behavior, and their commercial use for Taiwanese infants is growing. In Taiwan, lots of the advertisements for CFs employed health or diet claims to promote the products, simply the actual nutritional content of these CFs is not clear. The aim of this study was to compare the nutrient claims of commercial complementary food products with their actual diet facts. A sample of 363 commercial CFs was collected from websites, local supermarkets, and other food stores, and their nutrition-related claims were classified into composition, nutrition, and health categories. Although the World Health Arrangement recommends that infants should exist exclusively breastfed for the commencement 6 months, 48.2% of the commercial CFs were targeted at infants younger than 6 months. Therefore, marketing regulations should be implemented to curb early on weaning equally a result of products targeted at infants younger than 6 months. More than l% of Taiwanese commercial CFs have high carbohydrate content and more than 20% were high in sodium. Products with health claims, such equally "provides good diet to children" or "improves appetite," accept higher sodium or sugar content than do those without such claims. Moreover, products with calcium or atomic number 26 content claims did not contain more than calcium or iron than products without such claims. Additionally, a significantly greater proportion of the products with "no added sugar" claims were classified as having high saccharide content as compared to those without such claims. Parents cannot cull the healthiest food products for their children by just focusing on food claims. Government should regulate the labeling of nutrition facts and food claims for foods targeted at infants younger than 12 months.

Citation: Koo Y-C, Chang J-Southward, Chen YC (2018) Nutrient claims and nutrition facts of commercial infant foods. PLoS ONE thirteen(two): e0191982. https://doi.org/x.1371/journal.pone.0191982

Editor: Imelda Thousand. Moise, Academy of Miami, U.s.a.

Received: May 15, 2017; Accepted: January 15, 2018; Published: February 28, 2018

Copyright: © 2018 Koo et al. This is an open access article distributed under the terms of the Creative Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in whatsoever medium, provided the original writer and source are credited.

Information Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This piece of work was supported by the National Scientific discipline Council [grant number MOST103-2511-S-038-004-MY2 (ii-2)].

Competing interests: The authors have declared that no competing interests exist.

Introduction

The introduction of complementary food (CF) to infants is a turning point in the development of their eating behavior. The World Wellness System (WHO) recommends that infants should be exclusively breastfed for the first vi months and then start receiving CFs to provide critical nutrients (e.thou., atomic number 26 and zinc) for their development [ane–3]. Without a diet balanced nutrition, an baby might develop a nutritional deficiency. The general dominion for introducing CFs to infants is to provide an assortment of flavors and textures so that they can learn to accept a variety of foods [4]. Moreover, infants' sugar and salt intake should be express so that they develop healthy eating habits and avert chronic diseases later in life [5,vi].

Commercial CFs are convenient to include in an infant's diet. There are many different commercial CFs available—infant cereals, fruit purees, vegetable purees, meat purees, and infant cookies. An online survey of U.S. parents found that virtually select their children'south food and drinks according to the ingredients or claims on the product packaging; parents prefer drinks with low-calorie and natural claims [vii]. A study discovered that parents perceived products with health or nutrition claims to be more nutritious for their children [8]. However, a study in the Us showed that more than seventy% of children'due south foods with specific food content claims were high in saccharide, sodium, or fatty [9]. A study in Canada also found that more than 60% of commercial foods for infants and toddlers were high in sodium or sugar [10]. To prevent these food claims from misleading parents to purchase foods that are unhealthy for their children, the Codex Alimentarius Commission [11] stipulates that "diet and health claims shall not be permitted for foods for infants and young children except where specifically provided for in relevant Codex standards or national legislation." Nevertheless, the rules do non utilise in some countries. For example, no special rules exist in Taiwan regarding the wellness and nutrition claims of food for infants and immature children.

Recently, the use of commercial CFs for Taiwanese infants has been increasing [12]. In popular Taiwanese pregnancy and early on parenting magazines, 81% of the advertisements for CFs employed health or diet claims to promote the products, but the bodily nutritional content of these CFs is non clear [13]. Therefore, this study investigated the nutrient claims compared with actual nutrition facts for commercial CF products. The results may guide nutrition educators and future revisions of relevant national laws.

Material and methods

Data drove

Content analysis was used to investigate the packaging information on commercial CF products. In accord with methods used in previous studies [14–xvi], the samples were collected from websites, local supermarkets, and other food stores. We identified food products for purchase from the sections labeled "baby" or "infant" foods.

Infant foods produced past the xvi main infant food manufacturers in Taiwan were sought during the period of September 2015 to February 2016. The final sample consisted of 363 commercial CFs. Packaging information on each product was obtained from manufacturer websites and by viewing products in the shop. All the information on the food packaging was photocopied for reference and stored for subsequent content assay. No approval was required for collecting these data because they were publicly available.

All of the samples were semisolid or solid infant foods; drinks, soup stock, and milk products were excluded. Babe drinks or soup is seldom used in Taiwan. Milk products, such as infant or growing-upward formula, are ruled under dissimilar pieces of legislation. Products included uncomplicated purees or blended foods (soft, wet, and prepare-fabricated nutrient); infant cereals (powders that mix with breast milk or h2o); and infant cookies (eastward.k., biscuits, puffs, and teething cookies). Products with a single food ingredient, typically a starchy food, fruit, vegetable, or meat, are referred to as simple pureed foods; blended foods are products with 2 or more nutrient ingredients (east.g., purees mixing multiple foods, or porridge).

Coding process and categories

During the sample selection and photocopying process, common themes were noted and recorded. The first author used these themes to develop a coding grade, which was used to train 2 other researchers who subsequently pretested it using a sample of ads. The pretest verified that the coding form included the distinct categories required to classify the contents of these ads, although several new categories were added as necessary during the coding of the last sample. This process too verified that the categories were understood and used in the same way past the 3 researchers. Some small-scale modifications to the grade were made to improve clarity. Subsequently, all of the photocopied ads were coded separately by the 2 researchers, who consulted the start author over challenging coding decisions.

As Table 1 shows, the information was coded co-ordinate to the following variables: bones information, production category, recommended age, diet facts, loftier carbohydrate content, high sodium content, and food claims. Offset, the packaging information of the products was reviewed, classified, and coded. Second, the recommended age and nutrition-related message of each product were coded. The recommended age by manufacturers was grouped into the post-obit categories: Stage ane (4–6 months), Stage two (vii–9 months), and Phase three (ten–12 months). These historic period categories are commonly used on CF food packages in Taiwan.

Nutrient claims and nutrition facts

Prior to coding, all nutrition-related text that mentioned limerick, nutrition, or health was typed exactly equally it appeared on the packaging. Then claims were classified into composition, diet, and health categories. Composition claims refer to overarching representations of food ingredients or food quality (e.thou., "organic food") or the exclusion of ingredient types (e.yard., "gluten-complimentary" or "no preservatives") [17]. Nutrition claims refer to whatsoever representation that states or suggests that a food has, or excludes, a particular nutrient (e.g. "contains iron" or "no added salt") [11,eighteen]. Health claims refer to any representation that states or suggests that a relationship exists between a food (or a elective of that food) and wellness, such as nutrient role claims (e.g., dietary fiber improves digestion). This also includes claims that consuming the food (or its constituents) influences the normal functions or biological activities of the body in the context of the wider diet (due east.g., contributing to balanced diet or an improved appetite) [eleven].

The nutrition facts per 100g listed on food packaging were then coded. Co-ordinate to regulations on nutrition labeling in Taiwan, packaged food should exist labeled with the calorie, saccharide, poly peptide, total fatty, sugar, sodium, saturated fat, and trans fat content. Some of the infant cereals and cookies listed calcium or atomic number 26 content, and this was also recorded. The nutrition fact information for infant cereals were recorded after the powder was composite with water by following the preparation methods on the packaging. For example, three spoonfuls (xc g) of infant cereal powder was added to 210 mL of water for a Stage i production, and iv spoonfuls (120 g) of cereal powder was added to 240 mL of water for a Stage two production. Then, the nutritional content of 100 g of infant cereal meal was recorded.

High sodium content and high sugar content were also coded. A relevant study classified infant and toddler food with less than 130 mg of sodium per 100 m of product as "acceptable," which is the AI reference intake for children aged 1–iii years in Canada's Nutrient Guide [10]. The age categories in this written report were all ≦i year; therefore, foods with 130 mg sodium or more were considered to have high sodium content. According to WHO [6] recommendations, both adults and children should derive less than 10% of their daily calories from sugar. Therefore, foods with 10% or more than calories derived from sugar were defined as having high sugar content.

Intercoder reliability and statistical analysis

Kappa analysis was performed to assess the intercoder reliability between the two independent coders (0.41–0.lx = moderate; 0.61–0.80 = substantial; 0.81–1.00 = almost perfect) [xix]. This analysis was performed using SPSS version 19.0. Intercoder reliability between the two researchers was pilot-tested using the original content assay grade. The final kappa analysis was calculated from concluding coding of all ads which were coded past both researchers. All the kappa statistics were college than 0.80 and thus deemed acceptable.

Results are expressed as frequencies (n), percentages (%), or the mean ± SD. Pearson'south chi-square test was used to examine the associations between two variables (for example, between the food categories, food claims, and salt or carbohydrate content for each age stage). The Kolmogorov–Smirnov test was used to examination the normal distribution of all continuous variables. Statistical difference amidst the groups was evaluated using a one-way analysis of variance (ANOVA) test with the Scheffé or Kruskal–Wallis test. The Mann–Whitney U exam with Bonferroni adjustment was practical to examine pairwise differences followed by significance using the Kruskal–Wallis examination. Kruskal–Wallis test and The Mann–Whitney U exam were used when the variables are not normally distributed. Statistical analyses were performed using SPSS version 19.0. A p value lower than 0.05 was considered significant.

Results

A total of 363 CF products were considered. Most of the products displayed a recommended age on the bundle label, although 1.ane% (n = 4) did not display a recommended age and 34.7% (n = 126) did non brandish the sugar content. Therefore, the recommended age (north = 359) and saccharide content (n = 237) were investigated only if they were displayed on the label.

Distribution of different commercial CFs

Among all the CFs, 58.2% of the products were mixed foods (n = 211), fifteen.4% were simple pureed foods (northward = 56), thirteen.2% were infant cereal (north = 48), and thirteen.2% were babe cookies (due north = 48). In the CF product names, 27.1% of infant cereals (n = thirteen) and 42.9% of elementary pureed foods (northward = 24) included fruit in the name description (e.g., "Apple Puree"). Table 2 shows the distribution of CFs across the diverse food categories. Amid all the CFs, 48.two% were recommended for Stage one infants, 25.9% for Stage 2 infants, and 25.9% for Stage three infants. Most baby cereals and simple puree foods were for Phase ane infants, and more than 30% of the mixed foods were for Stage ane and Stage three infants. Approximately 70% of baby cookies were for Stage 2 infants.

Approximately 90% of the products had composition claims, with no significant distinctions found beyond the categories. Infant cereal and cookies had a significantly college proportion of nutrition claims (91.7% and 81.3% respectively) than did the other categories. Infant cereal besides had a significantly higher proportion of health claims (85.4%) than did the other categories. No significant stardom was constitute across product categories for the "no added salt" claim. But uncomplicated pureed foods and mixed foods had a "no added seasoning" claim. Baby cookies had a college proportion of high sodium content. Infant cereal had a higher proportion of "no added sugar" claims, nonetheless information technology had a higher proportion of loftier sugar content (68.four%), as did unproblematic pureed foods (70.7%) (Table 2).

Nutrition facts of dissimilar commercial CFs

Table three shows the nutrition facts across the food categories. Babe cookies had the highest calorie, carbohydrate, protein, fatty, sugar, and sodium content of all categories. The calorie and saccharide contents of infant cereal were higher than those of simple pureed foods and mixed foods, but there were no pregnant differences in the protein content beyond these 3 production categories.

Tabular array iv lists the diet facts co-ordinate to the age stages targeted by products. No significant differences were observed between the age stages for infant cereals. Stage ii simple pureed foods contained more calories, protein, total fat, and sodium than did Stage i products. The calorie, carbohydrate, protein, fat, and sodium content of the Stage 3 mixed foods was higher than that of the Phase 1 or Stage 2 mixed foods. Stage 3 babe cookies had a significantly higher saturated fat content than did those aimed at Stages 1 and 2.

Calcium and atomic number 26 claims versus content in baby cereal and babe cookies

Calcium content was labeled on 55 products and iron content on 33 products; 34 of the babe cereals and 21 of the babe cookies displayed calcium content, and 22 of the infant cereals and eleven of the infant cookies displayed atomic number 26 content. Table 5 presents the calcium and iron content for different ages.

For calcium content, Stage 2 infant cereals had higher calcium than did Stage i cereals. Stage ane babe cookies had higher calcium content than did Stage 2 cookies. No meaning differences were observed in calcium content across the age stages for infant cereals or cookies.

Food claims versus nutrition content

Table 6 shows the clan between loftier sodium or high sugar content and food claims. High sodium content was found for 23.4% of the CFs. Approximately 20%–xxx% of the products with any food merits had high sodium content. In particular, the products with health claims had a significantly higher proportion of loftier sodium content than did those without health claims. Moreover, 5% of the products with "no added seasoning" had loftier sodium content.

Loftier saccharide content was found in 54.4% of the CFs; approximately 50% of products with whatever food claims had loftier sugar content. Additionally, the products with "no added sugar" had a significantly college proportion of high sugar content than did those without such claims.

Associations between calcium and iron content and claims were examined. Calcium content was labeled on 55 products and atomic number 26 content on 33 products. The products with a "contains calcium" claim (northward = 36; 368.eight ± 340.3 mg) had significantly more than calcium than did products without such a claim (north = nineteen; 132.0 ± 87.0 mg) (p < 0.001). No pregnant divergence was observed between the products with a "contains iron" claim (n = 22; 8.4 ± xix.9 mg) and those without such a claim (north = 11; ix.1 ± 8.2 mg) (p = 0.914).

Discussion

Products for dissimilar age stages

This written report plant that 48.2% of the commercial CFs were targeted at infants younger than half dozen months, and previous studies have found that most infant food products are targeted at iv–6-month-old infants [14,sixteen]. In Taiwan, the Ministry building of Wellness and Welfare follows the WHO [3] recommendation that infants should be exclusively breastfed for the first half dozen months before introducing them to CFs. The International Lawmaking of Marketing of Breast-Milk Substitutes, which applies to CFs for infants younger than vi months, stipulates that CFs must non be marketed in ways that undermine exclusive and sustained breastfeeding [20]. In 2016, the World Health Associates also asserted that inappropriate promotions for infant foods must finish [21]. Notwithstanding, early on weaning and introduction to CFs has been demonstrably influenced past parental access to commercial baby foods targeted at infants younger than 6 months [22–24]. Like to nigh countries, Taiwan implemented only some aspects of the code. Just infant formula products for infants younger than 1 twelvemonth are prohibited from advertizement; no marketing regulations be regarding CFs in Taiwan. Therefore, marketing regulations should be adult and implemented to curb early weaning as a effect of products targeted at infants younger than half-dozen months.

As infants grow, they require more energy and poly peptide from CFs. WHO complementary feeding guidelines indicated that infants anile 6–eight months require an boosted 67–100 kcal per repast from CFs and infants aged 9–11 months require 75–100 kcal per meal [25]. Parents usually choose commercial CFs according to the recommended age on the nutrient packages and may expect the products for older infants to be more nutritious. This study did not ever observe an increasing trend of calorie or protein content over the age stages of the same nutrient category. Merely the calorie and poly peptide content of Stage 3 mixed foods was higher than that of Stage 1 or Stage 2. This is consequent with a previous study that reported college calorie and protein contents in mixed foods targeted at older infants than in those targeted at younger infants [fourteen]. Several infant feeding guidelines recommend that complementary feeding can starting time with a single nutrient, but then the multifariousness of foods and textures should be increased co-ordinate to the development of each infant [5,26]. Fe and calcium are two vital nutrients for baby health and development [one,5]. In this study, 33 products were labeled with iron content and 55 products with calcium content. Only Stage two products had significantly higher calcium content than those in Stage i products. Regulations in the United states of america stipulate that diet facts should indicate the atomic number 26 and calcium content [eighteen]; however, Taiwan does not crave these two nutrients to be listed. Thus, fe and calcium content data were not available on most food packages in this written report. Still, infant CF packaging should be legally mandated to display the information for calcium and iron so that parents can make better choices for their infants.

Loftier sugar/sodium content in different nutrient product category

Approximately lx% of the babe nutrient was mixed food. Compared with the other categories, there was a lower percent of mixed food with high carbohydrate content. Several infant feeding guidelines recommend that parents should cull foods that are light in season and avoid foods with added saccharide or sodium [one,5]. However, nosotros found that more than 50% of the products were high in saccharide. This is similar to a study conducted in the United kingdom of great britain and northern ireland showing that v.viii% of commerical weaning foods had added carbohydrate, and x% of them had more 10% of the total calories from sugar [16]. Moreover, more than half of infant and toddler foods in the United States were high in saccharide [xv]. Excessive consumption of sugar in young children is a serious public health trouble, considering dietary preferences develop at a young age and persist over fourth dimension [27].

Several infant feeding guidelines recommend that infant cereals or elementary pureed foods exist the first CFs introduced to infants [5,26,28]. However, the present study found that approximately seventy% of infant cereals and uncomplicated pureed foods had high sugar content, despite l% of baby cereals having a "no added sugar" claim. This might be because some infant cereal or pure fruit puree contains natural sugar.

Moreover, a Canadian survey found that some infant cereals or baby dessert purees had more than than xxx% of the total calories from saccharide, making them high-saccharide foods [ten]. Since these are usually the first CFs introduced to infants, high carbohydrate infant cereals and loftier saccharide puree food might pb to infants consuming excessive sugar [29]. Therefore, parents should pay careful attention to their infants' saccharide intake from infant cereals or fruit puree to avoid accustoming them to the sweet taste, to assist them avoid developing chronic diseases later in life.

A previous study indicated that 83.ii% of Taiwanese infants eat cookies earlier they are viii months erstwhile [12]. In Taiwan, infant cookies are used as a between-meal snack or a food that tin calm infants' emotions. Even so, the nowadays report found that more than than lx% of infant cookies are high in carbohydrate or sodium. These results are like to those of other studies. In the United Kingdom, baby cookies were shown to be high in sugar [sixteen]; in Canada, more than than 30% of infant cookies had a loftier proportion of calories from sugar, and 12% of them contained more 130 mg of sodium [10]. In the U.s.a., baby cookies had an average sodium content of 486 mg, making them a high-sodium food [xv]. Given these findings, parents should pay special attending to the sugar and sodium content when choosing cookies for their infants.

High sugar/sodium content of products with different food claims

This study found that nigh 90% of products had limerick claims, more twoscore% had nutrition claims, and approximately half had health claims on the packaging. A previous study in Taiwan also found that 80% of babe and toddler food advertisements in parenting magazines were promoted with nutritional or health claims [13]. Such nutrition marketing is commonly used to promote infant and toddler foods, and a previous study indicated that families with young children pay particular attention to such claims [30]. Nutrition or health claims increment parents' desire to buy the advertised foods [8]. The present written report revealed that more than 50% of products with nutrition or limerick claims had high sugar content, more than 40% of products with wellness claims had high sugar content, and more 30% of products with health claims had high sodium content. This finding is consistent with the finding of a previous study, which reported that 58.half-dozen% of toddler products in the U.s.a. were high in sodium and sugar, even though more than 70% of them had nutritional content claims [9]. A Canadian written report besides reported that 60% of child foods with such claims were high in sugar [31]. Foods with nutrition claims could mislead parents to perceive such products as more than nutritious, fifty-fifty when they are low-nutrient foods [32]. Wong et al. [33] indicated that considering of a lack of regulation in some countries, foods with nutrition claims may satisfy merely one nutritional content criterion and be high in some unhealthy nutrients. A previous study constitute that foods with diet or health claims but loftier sugar content might lead parents to make an fault in judgment and buy such products for their children [7]. Therefore, wellness professionals should educate parents to empathize and use the diet facts to consider the complete flick of food quality when selecting products, instead of simply focusing on the health or diet claims on nutrient packaging.

The American Academy of Pediatrics [34] encourages choosing "infant and toddler food […] whether habitation or commercially prepared, with no added salt or saccharide." In this study, of 50 products with "no added sugar" claims, 35 had loftier sugar content. This may because the products with "no added sugar" claims had fruit ingredients. Fruits are valuable sources of fiber, vitamins, and minerals; eating fruits is a role of a salubrious diet. Notwithstanding, García et al. [29] indicated that full saccharide content in UK commercial infant food is positively correlated with fruit and vegetable content, and this might mislead parents to reinforce their children'southward preference for sugariness food. This report likewise found that of 19 products with a "no added salt" claim, iv had high sodium content. The CAC recommends that nutrition and health claims should not be permitted for foods for toddlers younger than three years former, except where specifically provided for in relevant Codex standards or national legislation [eleven]. In the United States, diet claims must be accompanied with a disclosure statement if the product exceeds specified threshold levels of full fat (13 chiliad), saturated fatty (4 g), or sodium (480 mg) [35]. These policies may adjourn nutrition or health claims that mislead parents into selecting foods that are unsuitable for their infants' healthy development. The results of this study signal that pediatric health professionals must be aware of the marketing strategies commonly used on CFs, and help parents and other child caregivers to identify the true nutritional content of CFs. Future inquiry should examine the influence of diet marketing on parents' nutrient selection.

Limitations

This study is subject area to limitations. Kickoff, the collated sample could not embrace all commercial CFs in Taiwan, although nosotros did our best to collect information on the most widely available products. Second, some products lacked sugar content information, maybe because the labeling regulations regarding sugar content utilize only to products manufactured subsequently July 2015 [36]. Third, nosotros did not employ instrumental analysis to verify the nutritional content; thus, we could not comprehensively determine and compare the nutrient content of all sampled commercial CFs. Although nosotros adopted nonparametric testing to account for the small sample size, the small-scale sample size may engender a generalizability trouble. Finally, complementary foods are office of a various diet. The use of unhealthy commercial CFs differs from unhealthy infant diets.

Conclusions

More than than 50% of Taiwanese commercial CFs accept high sugar content and more than than xx% were loftier in sodium. Moreover, products with calcium or iron content claims did not contain more calcium or iron than products without such claims. The results indicated that parents in Taiwan cannot choose the healthiest foods for their children by simply focusing on nutrient claims. They must pay closer attending to the nutrition facts, especially the sodium and sugar content. Pediatric physicians, dietitians, and health professionals should educate parents on how to interpret the information on nutrient packaging so that they can cull the foods that are truly most suitable for their children'southward salubrious development. Given that few data for Taiwan'due south commercial CFs are available, the results of this report should exist useful to health professionals. Furthermore, the Taiwan government should regulate the labeling of diet facts and food claims for foods targeted at infants younger than 12 months.

Supporting information

Acknowledgments

The author wishes to acknowledge the help of Dr. Wei-Chu Chie, Dr. Pi-Chen Chang and Dr. Yen-Kuang Lin in commenting on an early typhoon of the thesis.

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Source: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0191982