Baby Care Products Information Diet and Nutrition Facts

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Open Access

Peer-reviewed

Research Article

Food claims and nutrition facts of commercial infant foods

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

ten

• Published: February 28, 2018
• https://doi.org/x.1371/journal.pone.0191982

Figures

Abstract

Composition claim, nutrition claim and health claim are often found 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 nutrition claims to promote the products, but the actual nutritional content of these CFs is not clear. The aim of this study was to compare the food 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 nutrient stores, and their diet-related claims were classified into composition, diet, and health categories. Although the Earth Health Organization recommends that infants should be exclusively breastfed for the showtime 6 months, 48.2% of the commercial CFs were targeted at infants younger than 6 months. Therefore, marketing regulations should be implemented to adjourn early weaning equally a consequence of products targeted at infants younger than 6 months. More than than l% of Taiwanese commercial CFs have high sugar content and more than than 20% were high in sodium. Products with health claims, such every bit "provides skillful nutrition to children" or "improves ambition," accept higher sodium or sugar content than do those without such claims. Moreover, products with calcium or iron content claims did non contain more 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 sugar content every bit compared to those without such claims. Parents cannot choose the healthiest food products for their children by only focusing on food claims. Government should regulate the labeling of nutrition facts and food claims for foods targeted at infants younger than 12 months.

Commendation: Koo Y-C, Chang J-South, Chen YC (2018) Nutrient claims and nutrition facts of commercial infant foods. PLoS One 13(2): e0191982. https://doi.org/10.1371/journal.pone.0191982

Editor: Imelda G. Moise, University of Miami, Us

Received: May fifteen, 2017; Accepted: Jan xv, 2018; Published: Feb 28, 2018

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

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

Funding: This work was supported by the National Science Council [grant number MOST103-2511-S-038-004-MY2 (two-two)].

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

Introduction

The introduction of complementary nutrient (CF) to infants is a turning betoken in the development of their eating behavior. The Globe Health System (WHO) recommends that infants should be exclusively breastfed for the starting time 6 months and then start receiving CFs to provide disquisitional nutrients (e.grand., iron and zinc) for their development [1–iii]. Without a nutrition balanced nutrition, an infant might develop a nutritional deficiency. The general rule for introducing CFs to infants is to provide an array of flavors and textures so that they can learn to accept a diversity of foods [4]. Moreover, infants' saccharide and salt intake should be express and so that they develop healthy eating habits and avoid chronic diseases later in life [5,6].

Commercial CFs are user-friendly 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 establish that nigh select their children's food and drinks according to the ingredients or claims on the production packaging; parents adopt drinks with low-calorie and natural claims [7]. A written report discovered that parents perceived products with wellness or nutrition claims to exist more nutritious for their children [eight]. All the same, a written report in the U.s. showed that more than lxx% of children'southward foods with specific nutrient content claims were loftier in carbohydrate, sodium, or fat [ix]. A study in Canada likewise found that more than than threescore% of commercial foods for infants and toddlers were loftier in sodium or sugar [10]. To prevent these food claims from misleading parents to buy foods that are unhealthy for their children, the Codex Alimentarius Commission [xi] stipulates that "nutrition and wellness 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 apply in some countries. For example, no special rules be in Taiwan regarding the wellness and nutrition claims of food for infants and young children.

Recently, the use of commercial CFs for Taiwanese infants has been increasing [12]. In popular Taiwanese pregnancy and early parenting magazines, 81% of the advertisements for CFs employed health or diet claims to promote the products, only the actual nutritional content of these CFs is not clear [13]. Therefore, this study investigated the food claims compared with actual nutrition facts for commercial CF products. The results may guide diet educators and future revisions of relevant national laws.

Cloth and methods

Data collection

Content analysis was used to investigate the packaging data on commercial CF products. In accordance with methods used in previous studies [fourteen–16], the samples were nerveless from websites, local supermarkets, and other nutrient stores. Nosotros identified nutrient products for purchase from the sections labeled "baby" or "infant" foods.

Infant foods produced by the 16 principal infant food manufacturers in Taiwan were sought during the period of September 2015 to February 2016. The concluding sample consisted of 363 commercial CFs. Packaging information on each product was obtained from manufacturer websites and by viewing products in the store. All the information on the nutrient packaging was photocopied for reference and stored for subsequent content analysis. No approval was required for collecting these information because they were publicly available.

All of the samples were semisolid or solid baby foods; drinks, soup stock, and milk products were excluded. Infant drinks or soup is seldom used in Taiwan. Milk products, such every bit babe or growing-upwardly formula, are ruled under different pieces of legislation. Products included simple purees or blended foods (soft, wet, and gear up-made food); infant cereals (powders that mix with breast milk or water); and infant cookies (e.g., biscuits, puffs, and teething cookies). Products with a single food ingredient, typically a starchy nutrient, fruit, vegetable, or meat, are referred to equally simple pureed foods; blended foods are products with two or more than nutrient ingredients (e.g., purees mixing multiple foods, or porridge).

Coding process and categories

During the sample selection and photocopying procedure, common themes were noted and recorded. The first author used these themes to develop a coding form, which was used to train 2 other researchers who afterward 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 equally necessary during the coding of the final sample. This process also verified that the categories were understood and used in the same style by the three researchers. Some minor modifications to the course were made to improve clarity. Subsequently, all of the photocopied ads were coded separately by the two researchers, who consulted the get-go author over challenging coding decisions.

As Tabular array i shows, the data was coded according to the following variables: basic information, product category, recommended historic period, diet facts, high carbohydrate content, high sodium content, and nutrient claims. Start, the packaging data of the products was reviewed, classified, and coded. Second, the recommended age and diet-related message of each product were coded. The recommended historic period by manufacturers was grouped into the following categories: Phase i (4–6 months), Stage 2 (7–9 months), and Phase 3 (ten–12 months). These age categories are normally used on CF food packages in Taiwan.

Food claims and diet facts

Prior to coding, all nutrition-related text that mentioned composition, nutrition, or health was typed exactly as information technology appeared on the packaging. So claims were classified into composition, nutrition, and health categories. Composition claims refer to overarching representations of food ingredients or food quality (eastward.g., "organic food") or the exclusion of ingredient types (e.one thousand., "gluten-free" or "no preservatives") [17]. Nutrition claims refer to any 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 human relationship exists between a nutrient (or a elective of that food) and health, such as nutrient function claims (e.grand., dietary cobweb improves digestion). This besides 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 nutrition (east.chiliad., contributing to balanced nutrition or an improved appetite) [11].

The nutrition facts per 100g listed on food packaging were then coded. Co-ordinate to regulations on nutrition labeling in Taiwan, packaged food should be labeled with the calorie, carbohydrate, protein, total fat, sugar, sodium, saturated fatty, and trans fat content. Some of the infant cereals and cookies listed calcium or iron content, and this was also recorded. The nutrition fact data for infant cereals were recorded later the powder was composite with h2o past following the preparation methods on the packaging. For instance, iii spoonfuls (90 thou) of babe cereal powder was added to 210 mL of water for a Stage i product, and four spoonfuls (120 thousand) of cereal powder was added to 240 mL of h2o for a Stage 2 product. And 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 nutrient with less than 130 mg of sodium per 100 one thousand of product every bit "adequate," which is the AI reference intake for children anile 1–iii years in Canada's Food Guide [10]. The historic period categories in this report were all ≦one 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 calories derived from sugar were defined as having high carbohydrate content.

Intercoder reliability and statistical assay

Kappa assay was performed to appraise the intercoder reliability between the two independent coders (0.41–0.60 = moderate; 0.61–0.80 = substantial; 0.81–1.00 = almost perfect) [xix]. This analysis was performed using SPSS version 19.0. Intercoder reliability betwixt the two researchers was airplane pilot-tested using the original content analysis course. The terminal kappa analysis was calculated from final coding of all ads which were coded by both researchers. All the kappa statistics were higher than 0.80 and thus accounted acceptable.

Results are expressed every bit frequencies (n), percentages (%), or the mean ± SD. Pearson's chi-square exam was used to examine the associations between two variables (for instance, between the food categories, food claims, and salt or sugar content for each age stage). The Kolmogorov–Smirnov test was used to examination the normal distribution of all continuous variables. Statistical deviation amid the groups was evaluated using a 1-way analysis of variance (ANOVA) examination with the Scheffé or Kruskal–Wallis test. The Mann–Whitney U exam with Bonferroni adjustment was applied to examine pairwise differences followed past significance using the Kruskal–Wallis test. Kruskal–Wallis examination and The Isle of mann–Whitney U examination 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 pregnant.

Results

A total of 363 CF products were considered. Most of the products displayed a recommended age on the packet characterization, although 1.ane% (due north = iv) did not display a recommended age and 34.7% (n = 126) did not display the sugar content. Therefore, the recommended age (n = 359) and carbohydrate content (n = 237) were investigated merely if they were displayed on the label.

Distribution of unlike commercial CFs

Amongst all the CFs, 58.two% of the products were mixed foods (n = 211), 15.iv% were elementary pureed foods (n = 56), thirteen.2% were baby cereal (n = 48), and 13.ii% were infant cookies (n = 48). In the CF product names, 27.i% of infant cereals (due north = thirteen) and 42.nine% of simple pureed foods (due north = 24) included fruit in the proper noun description (e.g., "Apple Puree"). Table 2 shows the distribution of CFs across the various food categories. Amid all the CFs, 48.two% were recommended for Stage i infants, 25.9% for Stage 2 infants, and 25.9% for Stage iii infants. Almost babe cereals and unproblematic puree foods were for Stage 1 infants, and more than than thirty% of the mixed foods were for Phase 1 and Stage 3 infants. Approximately 70% of baby cookies were for Stage ii infants.

Approximately 90% of the products had composition claims, with no significant distinctions establish across the categories. Infant cereal and cookies had a significantly college proportion of diet claims (91.7% and 81.3% respectively) than did the other categories. Infant cereal also had a significantly higher proportion of wellness claims (85.iv%) than did the other categories. No significant distinction was found across product categories for the "no added salt" claim. Only simple pureed foods and mixed foods had a "no added seasoning" claim. Infant cookies had a higher proportion of high sodium content. Infant cereal had a college proportion of "no added sugar" claims, yet information technology had a higher proportion of high sugar content (68.4%), as did simple pureed foods (seventy.seven%) (Tabular array 2).

Nutrition facts of different commercial CFs

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

Tabular array 4 lists the nutrition facts co-ordinate to the historic period stages targeted by products. No significant differences were observed between the age stages for infant cereals. Stage 2 simple pureed foods contained more calories, protein, total fat, and sodium than did Stage 1 products. The calorie, sugar, protein, fat, and sodium content of the Stage iii mixed foods was higher than that of the Stage 1 or Stage 2 mixed foods. Stage three infant cookies had a significantly higher saturated fat content than did those aimed at Stages 1 and 2.

Calcium and iron claims versus content in infant cereal and infant cookies

Calcium content was labeled on 55 products and iron content on 33 products; 34 of the infant cereals and 21 of the infant cookies displayed calcium content, and 22 of the baby cereals and 11 of the infant cookies displayed iron 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 1 cereals. Stage 1 infant cookies had higher calcium content than did Stage two cookies. No significant differences were observed in calcium content across the historic period stages for infant cereals or cookies.

Food claims versus nutrition content

Table 6 shows the clan between loftier sodium or high carbohydrate content and food claims. High sodium content was found for 23.iv% of the CFs. Approximately xx%–30% of the products with any nutrient merits had loftier sodium content. In particular, the products with health claims had a significantly higher proportion of high sodium content than did those without health claims. Moreover, v% of the products with "no added seasoning" had high sodium content.

High saccharide content was plant in 54.4% of the CFs; approximately l% of products with any nutrient claims had high sugar content. Additionally, the products with "no added sugar" had a significantly higher proportion of high saccharide content than did those without such claims.

Associations betwixt calcium and iron content and claims were examined. Calcium content was labeled on 55 products and iron content on 33 products. The products with a "contains calcium" claim (n = 36; 368.eight ± 340.three mg) had significantly more than calcium than did products without such a claim (n = xix; 132.0 ± 87.0 mg) (p < 0.001). No significant deviation was observed betwixt the products with a "contains iron" claim (due north = 22; viii.4 ± 19.9 mg) and those without such a claim (due north = 11; 9.i ± 8.two mg) (p = 0.914).

Give-and-take

Products for different age stages

This written report institute 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 4–6-month-old infants [14,16]. In Taiwan, the Ministry of Health 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 Code of Marketing of Chest-Milk Substitutes, which applies to CFs for infants younger than 6 months, stipulates that CFs must non be marketed in ways that undermine sectional and sustained breastfeeding [20]. In 2016, the World Wellness Assembly also asserted that inappropriate promotions for infant foods must end [21]. However, early weaning and introduction to CFs has been demonstrably influenced past parental access to commercial baby foods targeted at infants younger than vi months [22–24]. Similar to near countries, Taiwan implemented but some aspects of the lawmaking. Just babe formula products for infants younger than one year are prohibited from advert; no marketing regulations be regarding CFs in Taiwan. Therefore, marketing regulations should be developed and implemented to curb early on weaning every bit a effect of products targeted at infants younger than 6 months.

Equally infants grow, they require more free energy and protein from CFs. WHO complementary feeding guidelines indicated that infants aged half dozen–8 months require an additional 67–100 kcal per meal from CFs and infants aged 9–11 months require 75–100 kcal per repast [25]. Parents ordinarily choose commercial CFs according to the recommended age on the food packages and may expect the products for older infants to be more nutritious. This study did non e'er find 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 iii mixed foods was college than that of Stage ane or Stage 2. This is consistent with a previous study that reported higher calorie and protein contents in mixed foods targeted at older infants than in those targeted at younger infants [14]. Several babe feeding guidelines recommend that complementary feeding tin can start with a unmarried nutrient, but and then the diverseness of foods and textures should exist increased according to the development of each infant [v,26]. Iron and calcium are two vital nutrients for infant health and development [one,5]. In this study, 33 products were labeled with iron content and 55 products with calcium content. Only Phase 2 products had significantly college calcium content than those in Stage ane products. Regulations in the United States stipulate that nutrition facts should indicate the iron and calcium content [xviii]; even so, Taiwan does not require these two nutrients to be listed. Thus, fe and calcium content data were not available on most nutrient packages in this written report. Nonetheless, baby CF packaging should be legally mandated to display the data for calcium and iron so that parents can make amend choices for their infants.

High sugar/sodium content in different food product category

Approximately lx% of the infant food was mixed food. Compared with the other categories, there was a lower per centum of mixed food with high sugar content. Several infant feeding guidelines recommend that parents should choose foods that are low-cal in flavor and avoid foods with added carbohydrate or sodium [one,5]. Nevertheless, we found that more than than 50% of the products were high in carbohydrate. This is like to a study conducted in the U.k. showing that 5.viii% of commerical weaning foods had added sugar, and ten% of them had more than x% of the full calories from sugar [16]. Moreover, more than one-half of infant and toddler foods in the U.s.a. were loftier in sugar [15]. Excessive consumption of sugar in young children is a serious public health problem, considering dietary preferences develop at a young historic period and persist over time [27].

Several infant feeding guidelines recommend that infant cereals or elementary pureed foods be the first CFs introduced to infants [5,26,28]. However, the nowadays study institute that approximately 70% of infant cereals and simple pureed foods had high sugar content, despite 50% of infant cereals having a "no added carbohydrate" claim. This might be because some babe cereal or pure fruit puree contains natural saccharide.

Moreover, a Canadian survey found that some infant cereals or baby dessert purees had more xxx% of the total calories from sugar, making them loftier-carbohydrate foods [10]. Since these are unremarkably the beginning CFs introduced to infants, high sugar baby cereals and high sugar puree food might lead to infants consuming excessive sugar [29]. Therefore, parents should pay careful attention to their infants' sugar intake from infant cereals or fruit puree to avoid accustoming them to the sweet gustation, to assistance them avoid developing chronic diseases later in life.

A previous study indicated that 83.2% of Taiwanese infants eat cookies earlier they are 8 months onetime [12]. In Taiwan, babe cookies are used as a between-meal snack or a nutrient that can at-home infants' emotions. However, the present written report found that more than lx% of baby cookies are loftier in saccharide or sodium. These results are similar to those of other studies. In the Britain, infant cookies were shown to be loftier in sugar [16]; in Canada, more thirty% of infant cookies had a high proportion of calories from carbohydrate, and 12% of them contained more than 130 mg of sodium [10]. In the United States, infant cookies had an average sodium content of 486 mg, making them a high-sodium food [xv]. Given these findings, parents should pay special attention to the sugar and sodium content when choosing cookies for their infants.

High sugar/sodium content of products with unlike food claims

This study found that nearly 90% of products had limerick claims, more than 40% had nutrition claims, and approximately half had wellness claims on the packaging. A previous study in Taiwan besides found that 80% of infant and toddler food advertisements in parenting magazines were promoted with nutritional or health claims [xiii]. Such nutrition marketing is unremarkably used to promote infant and toddler foods, and a previous written report indicated that families with immature children pay particular attention to such claims [xxx]. Nutrition or health claims increment parents' want to purchase the advertised foods [8]. The nowadays study revealed that more than l% of products with nutrition or composition claims had high saccharide content, more than twoscore% of products with wellness claims had high carbohydrate content, and more than 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.vi% of toddler products in the U.s.a. were high in sodium and sugar, fifty-fifty though more than 70% of them had nutritional content claims [nine]. A Canadian study also 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 nutritious, fifty-fifty when they are low-nutrient foods [32]. Wong et al. [33] indicated that because of a lack of regulation in some countries, foods with nutrition claims may satisfy only one nutritional content criterion and be high in some unhealthy nutrients. A previous study found that foods with nutrition or wellness claims but loftier sugar content might lead parents to make an error in judgment and purchase such products for their children [7]. Therefore, health professionals should brainwash parents to sympathise and use the nutrition facts to consider the consummate picture of food quality when selecting products, instead of simply focusing on the wellness or nutrition claims on food packaging.

The American Academy of Pediatrics [34] encourages choosing "infant and toddler food […] whether abode or commercially prepared, with no added table salt or sugar." In this study, of fifty products with "no added carbohydrate" claims, 35 had high sugar content. This may considering the products with "no added sugar" claims had fruit ingredients. Fruits are valuable sources of cobweb, vitamins, and minerals; eating fruits is a role of a healthy diet. However, García et al. [29] indicated that total carbohydrate content in Great britain commercial infant nutrient is positively correlated with fruit and vegetable content, and this might mislead parents to reinforce their children'south preference for sweetness food. This study also found that of 19 products with a "no added salt" claim, iv had loftier sodium content. The CAC recommends that nutrition and wellness claims should not exist permitted for foods for toddlers younger than iii years erstwhile, except where specifically provided for in relevant Codex standards or national legislation [11]. In the United States, nutrition claims must exist accompanied with a disclosure statement if the production exceeds specified threshold levels of total fat (thirteen thou), saturated fatty (4 yard), or sodium (480 mg) [35]. These policies may curb nutrition or health claims that mislead parents into selecting foods that are unsuitable for their infants' healthy evolution. The results of this study indicate that pediatric wellness professionals must exist aware of the marketing strategies commonly used on CFs, and help parents and other child caregivers to place the true nutritional content of CFs. Future enquiry should examine the influence of nutrition marketing on parents' food selection.

Limitations

This report is field of study to limitations. First, the collated sample could non comprehend all commercial CFs in Taiwan, although we did our best to collect data on the most widely available products. Second, some products lacked sugar content information, perhaps because the labeling regulations regarding sugar content apply merely to products manufactured afterward July 2015 [36]. Third, nosotros did not use instrumental assay to verify the nutritional content; thus, nosotros could not comprehensively determine and compare the nutrient content of all sampled commercial CFs. Although we adopted nonparametric testing to account for the small sample size, the small sample size may engender a generalizability problem. Finally, complementary foods are role of a various diet. The utilise of unhealthy commercial CFs differs from unhealthy infant diets.

Conclusions

More than 50% of Taiwanese commercial CFs have high saccharide content and more than than xx% were high in sodium. Moreover, products with calcium or iron content claims did non 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 but focusing on food claims. They must pay closer attention to the diet facts, particularly the sodium and carbohydrate content. Pediatric physicians, dietitians, and health professionals should educate parents on how to interpret the information on nutrient packaging so that they can choose the foods that are truly nigh suitable for their children's healthy development. Given that few data for Taiwan's commercial CFs are available, the results of this study should be useful to health professionals. Furthermore, the Taiwan government should regulate the labeling of nutrition facts and food claims for foods targeted at infants younger than 12 months.

Supporting information

Acknowledgments

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

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

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