A formula for concern: The boom of milk-based formula sales

PHN Editorial Highlight: ‘Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?
Blog by Phillip Baker

To ensure children get the best start in life the World Health Organization recommends that infants are exclusively breastfed to six months of age with ongoing breastfeeding for up to two years of age and beyond. Yet worldwide the prevalence of infants exclusively breast fed to six months hovers at around 37% and has improved only marginally in recent decades.

In contrast, the study of 80 countries demonstrates that global milk-based formula sales are booming. In the five-years between 2008 and 2013 world total milk formula sales grew by 40.8% from 5.5 to 7.8kg per infant/child, a figure projected to increase to 10.8kg by 2018.

This global sales boom applies not only to infant formula (for consumption by infants aged 0-6 months) but also to follow-up (7-12 months) and toddler (13-36 months) formulas, which can displace ongoing breastfeeding if marketed and consumed inappropriately.

We describe this as indicative of a global ‘infant and young child feeding transition’ i.e. a shift from lower to higher formula diets at the population level. Although the idea of such a transition is not new, the rate and scale of change described in the study is potentially unprecedented.

Growth has been especially rapid in several industrialising countries in Asia: China, Indonesia, Malaysia, Vietnam and Thailand. As home to the world’s second largest infant/child population (~41 million aged 0-36 months in 2013) the most significant absolute change has been in China. Other highly-populated countries undergoing significant growth include South Africa, Iran, Turkey, Brazil and Peru.

These results are troubling because formula-fed children experience poorer health and developmental outcomes than breastfed children including an increased risk of death, pneumonia, diarrhoea, obesity and type-2 diabetes, ear infections and asthma. Formula feeding also harms mothers due to the forgone protective effects of breastfeeding against breast and ovarian cancer.

Infant and young child feeding is typically portrayed as an individual behaviour, as a matter of free parental choice. The study offers a counter-view – the observed results are likely to reflect transformations in wider social, economic and social systems that structure infant and young child feeding choices at the population level.

In this view, the global infant and young child feeding transition is driven largely by the expansion of transnational formula companies and more intensive formula marketing, the shift of labour and production out of the home (especially in Asia’s vast manufacturing centres where millions of women have become employed, often with no or limited maternity protections), and the failure of regulations and policies designed to promote, protect and support breastfeeding in these new contexts.

These findings are important for several reasons. The results raise serious concern that the rapid changes observed are not being captured in a timely manner by existing international nutrition monitoring systems.

Existing regulations intended to protect the health of children and mothers and to prevent unethical formula marketing are not working effectively. Renewed efforts towards the implementation, monitoring and enforcement of the International Code of Marketing of Breast-Milk Substitutes, including stronger accountability mechanisms for governments and industry are urgently needed.

Stronger maternity protections that enable breastfeeding (e.g. adequate maternity leave, paid lactation breaks, flexible working hours, and nursing facilities) are also urgently needed for millions of working mothers, especially in Africa and Asia.

This can only come about through greater political priority and strengthened governance mechanisms for infant and young child nutrition.

The paper, ‘Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?’ is published in the journalPublic Health Nutrition and is freely available until 12th June 2016.
Authors: Phillip Baker, Julie Smith, Libby Salmon, Sharon Friel, George Kent, Alessandro Iellamo, JP Dadhich, Mary J Renfrew.
Funding: This analysis was unfunded. However, the lead author was employed through an Australian Research Council Discovery Project (number 130101478).

Source: A formula for concern: The boom of milk-based formula sales – Cambridge Journals Blog

Advertisements

Rising risk of obesity among China’s ‘left behind children’

Boys in Rural ChinaThe December Nutrition Society paper of the month, is from Public Health Nutrition and is entitled, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China.’

Some 61 million rural children left behind by parents moving to China’s booming urban centres are at risk from increased fat and reduced protein in their diets.

The study of 975 children from 140 rural villages in nine provinces carefully analysed nutritional intake and showed a particular risk to boys who were left behind in the care of grandparents or a mother who sought work away from home.

There are sound financial reasons why so many people move from rural to urban areas in China, but the benefits that more money brings to a family can often be at the expense of child nutrition. The Chinese government needs to recognise this growing problem among rural communities and this research provides some evidence to target health policies on encouraging a balanced diet.

The study finds that ‘left behind’ boys in particular consumed more fat and less protein than those from complete families, which potentially leaves them at increased risk of obesity and stunted growth. This has important policy implications in a specific cultural-context where son preferences are powerful.

Although the results of the study don’t provide reasons for this change in diet, we speculate that mothers moving away from home generally earn less, and that these lower earnings act in combination with grandparents’ poorer dietary knowledge or willingness to spend more on food.

Another factor at work could be that prices of protein-based foods such as eggs and meat have increased faster than many households’ incomes – meaning that even though money is being sent home from one or both parents, nutrition doesn’t always improve.

The process of parental migration is complex and the reasons for problems in boys’ nutrition are not straightforward, however we can see that both parents and grandparents in rural areas need to be educated about good diet.

Because raising children can fall on all members of the family, good care-giving practice needs to become more widespread.

The paper, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China,’ was published in the journal, Public Health Nutrition and is available to read in full at http://journals.cambridge.org/ns/dec15

Authors Nan Zhang, Laia Bécares and Tarani Chandola

Funding- Economic and Social Research Council (ESRC) Postgraduate Scholarship

Better Diet Quality may Improve Cognition in Children

Author: Eero Haapala

A recent Finnish study shows that better diet quality is related to better cognitive performance among 6–8 year old children. The results published in the British Journal of Nutrition are part of the Physical Activity and Nutrition in Children (PANIC) Study conducted at the University of Eastern Finland. The study investigated the relationships of the Baltic Sea type and the Dietary Approaches to Stop Hypertension (DASH) dietary patterns to cognition in a population based sample of 428 children aged 6–8 years. Stricter adherence to the Baltic Sea type and the DASH dietary patterns, indicated by a higher consumption of vegetables, fruit and berries, fish, whole grain products, and a lower consumption of red meat, was associated with better cognitive performance. Of the components of these dietary patterns particularly higher consumption of vegetables, fruit and berries and fish and a lower consumption of red meat was related to better cognition. The associations of dietary patterns with cognition were stronger in boys than in girls. In conclusion, a poorer diet quality was associated with worse cognition in children and the relationship was stronger in boys than in girls.

This article is freely available for two weeks via the following link: journals.cambridge.org/bjn/panic

Source: Better Diet Quality may Improve Cognition in Children « Journals in the News « Cambridge Journals Blog

Do higher vitamin E levels have a protective effect on pulmonary condition in Cystic Fibrosis?

The  July Nutrition  Paper of the Month is entitled ‘Vitamin E intake, The affect of  levels and pulmonary function in children and adolescents with cystic fibrosis’

Cystic fibrosis (CF) is a life-threating genetic disorder, characterised by chronic pulmonary inflammation that causes a gradual, progressive decline in pulmonary function, partly due to oxidative stress. Most patients have pancreatic insufficiency, leading to intestinal malabsorption of fat and fat-soluble vitamins. Therefore, lifelong treatment with fat-soluble vitamins such as vitamin E has become standard care.

It has been suggested that higher vitamin E levels, expressed as serum α-tocopherol levels, have a protective effect on pulmonary condition in CF. However, serum α-tocopherol levels are compromised during a pulmonary exacerbation and recover with resolution of the inflammation. Likewise, chronic pulmonary inflammation may reduce levels, and the suggested association between vitamin E levels and pulmonary function might be secondary.

Whether current recommendations for vitamin E supplementation are optimal for preventing deficiency and whether higher serum α-tocopherol levels have beneficial effects on pulmonary function are subjects of debate. The present paper studied the association between vitamin E intake (dietary intake plus prescribed supplementation), the coefficient of fat absorption and chronic inflammation on serum α-tocopherol levels, and the long-term effect of both serum α-tocopherol levels and chronic inflammation on pulmonary function in paediatric patients with CF.

Results

In our study sample, we found no clear effect of vitamin E intake, the coefficient of fat absorption or chronic inflammation on serum α-tocopherol levels. Moreover, patients with CF received vitamin E supplementation at half the CF-specific recommended dosage; nevertheless, serum α-tocopherol levels were normal.

Furthermore, we found that chronic inflammation was inversely associated with pulmonary function and we found no association between serum α-tocopherol levels and pulmonary function. Paradoxically, we even found an overall trend towards a lower pulmonary function in those with higher serum α-tocopherol levels.

Conclusions

Our results suggest that the CF-specific vitamin E recommendations are higher than necessary to prevent deficiencies. Therefore, vitamin E dosages of 50% of the recommendations could be used, at least initially. We found no evidence that higher serum α-tocopherol levels had protective effects on pulmonary function in paediatric patients with CF. Moreover, the finding of higher serum α-tocopherol levels in patients with lower pulmonary function casts doubt on the hypothesis that vitamin E has therapeutic benefits.

This paper is freely acvailablke via the following link for one month: journals.cambridge.org/ns/jul15

Authors: Janna W. Woestenenk, Nancy Broos, Rebecca K. Stellato, Hubertus G. M. Arets, Cornelis K. van der Ent and Roderick H. J. Houwen

Nutrition Society Paper of the Month

Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). This paper is freely available for one month.

Pregnant women lack guidance on iodine intake levels


Pregnant women are not getting enough information about the need to include iodine in their diets, despite high awareness of general advice for pregnancy nutrition.

While 96% of pregnant women surveyed by researchers were aware of general nutritional recommendations for pregnant women, only 12% were aware of iodine-specific advice.

The study, published in the British Journal of Nutrition, estimated the median intake of iodine during pregnancy was 190 micrograms (ug) per day, with 74% consuming less than the World Health Organisation (WHO) recommended intake of 250ug daily.

Iodine is required for the production of thyroid hormones, which are crucial for fetal development with links between iodine deficiency and developmental impairments.

Dr Emilie Combet, who led the reserch at the University of Glasgow, said: “Women aren’t receiving the message about the importance of iodine in pregnancy, meaning they cannot make informed choices to ensure they get the amount they require.”

Iodine deficiency affects 1.9 billion people globally and is the most preventable cause of intellectual disability. The UK is ranked 8th in a list of iodine-deficient countries in the world.

The main sources of iodine-rich foods are seafood and dairy products, and in some countries iodine-fortified salt or bread. In the UK, the Reference Nutrient Intake (RNI) for adults is 140ug per day, with no proposed increment for pregnant and lactating women.

Unborn children and young infants are entirely reliant on their mother for iodine supply, making babies and pregnant or lactating mothers the most vulnerable groups of the population.

At present there is no recommendation for routine iodine supplementation in the UK unlike folic acid and Vitamin D, or routine testing in pregnancy that would reflect iodine levels, as there is with iron.

The study surveyed 1,026 women across the UK who were pregnant or mothers of children aged up to 36 months. Participants were asked about their awareness of nutritional guidelines and completed a food frequency questionnaire.

Knowledge of iodine-rich foods was low, with 56% unable to identify any iodine-rich food and the majority wrongfully believing dark green vegetables and table salt had high levels. Most, 84% were unaware that iodine from diet is important for the healthy development of the unborn baby, and only 11% had heard about iodine from a healthcare professional.

Dr Combet said: “Iodine is crucial during pregnancy and the first months of life, to ensure adequate brain development, but achieving over 200ug a day of iodine through diet requires regular consumption of iodine-rich foods such as milk and sea fish. Not everyone will have the knowledge, means or opportunity to achieve this.

“There is an ongoing debate as to whether there should be some form of fortification of food with iodine. Iodine-fortified salt is common in other countries, but using salt as the delivery method has raised concerns since it is perceived to clash with public health messaging around reducing salt intake to combat high blood pressure. However, other countries have demonstrated that both measures could be held simultaneously. We need to work toward a solution.

“The most important issue to come from this study, however, was the lack of awareness of the important role iodine plays in fetal development and how to consume adequate levels of this essential mineral. This is something that needs to be addressed. Our current Yorkhill Children Charity – funded project us developing tools and resources for health care professionals and women either pregnant or planning a pregnancy.”

This paper is freely available for 2 weeks

Related links

Dr Emilie Combet: researcher profile

Media enquiries: stuart.forsyth@glasgow.ac.uk / 0141 330 4831

Pregnant women are exceeding weight gain guidelines

Mums-to-be are advised to watch their “overall food intake and takeaway consumption” following the results of a new study on the health behaviours and psychological well-being of pregnant women in Ireland.

The findings published in the scientific journal Public Health Nutrition reveal that almost two-thirds (62.5%) of women in Ireland exceed the recommended levels* of weight gain during pregnancy.

According to the study, pregnant women who report eating “a little more food” during their pregnancy are 60% more likely to gain excessive weight over the course of their pregnancy than those women who report eating “about the same” as before they became pregnant. It also shows that women who report eating “a lot more food” during their pregnancy are twice as likely to exceed weight gain guidelines.

The study identifies “increased food intake and takeaway consumption” as two key drivers of weight gain during pregnancy. To conduct the study researchers at University College Dublin and the National Maternity Hospital examined four health behaviours of almost 800 pregnant women: food intake, physical activity, sleep and smoking. They also assessed additional dietary behaviours including the frequency of takeaway and fried food consumption and the number of snacks eaten per day.

The findings show that foreign nationals living in Ireland are almost twice as likely as women born in Ireland to gain excessive weight over the course of their pregnancy.

“Excessive weight gain during pregnancy has significant implications for infant growth and obesity, with potential implications for later adult health,” says Fionnuala McAuliffe, Professor of Obstetrics and Gynaecology at UCD School of Medicine & Medical Science, University College Dublin, and the National Maternity Hospital, Holles Street, Dublin, who co-authored the study.

“With these findings, public health campaigns can be better designed to target the types of dietary changes required to bring weight gain during pregnancy into line with the recommended guidelines.”

Women who were overweight before they became pregnant were also shown to be the most likely to gain excessive weight during their pregnancy. This matches findings from many other studies in this area. “To our knowledge, this is the first study to find an independent association between consumption of takeaway meals and weight gain during pregnancy,” says Dr Emily Heery of the UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, the lead author of the study. 53% of the women who took part in the study were first time mums-to-be, 30% were foreign nationals, and almost half (47%) had obtained at least a degree qualification. Over half (55%) of the women had private health insurance.

The article is freely available until 27 February 2015.

– Dr Emily Heery

How to measure mood in nutrition research

The January Nutrition Society Paper of the Month is from Nutrition Research Reviews  and is entitled “’How to Measure Mood in Nutrition Research”.

Mood is widely assessed in nutrition research, usually with rating scales. We have been researching the effects of food on mood for over twenty years, which has highlighted concerns about how mood is measured, one result of which is this review; we have been working on it intermittently ever since.

From early on, we had serious concerns because the mood effects of food are often fragile and hard to replicate, yet many foodstuffs are marketed and consumed on the assumption that they affect mood, at least by being pleasurable, and perhaps also by having functional effects on the nervous system. One of the striking but hard to substantiate claims made repeatedly since the 1960s was that sugar has drug-like effects by artificially elevating mood, followed by a rebound ‘sugar blues’ requiring further consumption of sugar. Consequently, we have largely focused on sucrose in our research.

There are some basic problems with how mood is measured. The questionnaires used to rate mood have not always been shown to be sensitive to relatively rapid ‘transient’ changes in mood because they were designed to compare mood over different days or weeks, as in the study of depression.  It is therefore possible that nutrition research often fails to detect mood effects of food that actually exist.

Another difficulty is that the use of different rating scales in different combinations, given at different times, in different experimental designs, propagates inconsistent and uncertain results. Mood rating can be affected by many aspects of an experiment other than the food given, and generally research participants should be blind to the experimental manipulation.

There are other more theoretical difficulties: It is commonly assumed that mood is what mood scales measure, most often arousal, and positive versus negative mood; It is also often assumed that rated mood is an unproblematic measure of experienced subjective mood, which is in turn related to underlying physiological condition. So for instance rating oneself aroused means you feelaroused and are aroused by measures such as skin conductance and heart rate. In reality, rated mood, phenomenological mood and physiological state are correlated with each other, but can vary separately and be affected by different causes. For instance, it is possible for mood ratings to change without there being an underlying conscious experience of change. As well as improving methods of rating mood, there is a need for a better theory of how mood and mood rating work. This review along with an earlier paper in Neuroscience and Biobehavioral Reviews is our attempt to improve practice in the assessment and understanding of mood in nutrition research.

– Professor Richard Hammersley

This paper is freely available for one month via the following link: journals.cambridge.org/ns/Jan15

%d bloggers like this: