Nutritional Formula for Infants and Young Children

*University of Lancashire, Lancashire, United Kingdom; †University of Milano, Milano, Italy; ‡University of Lund, Malmo, Sweden; §Hopital des Enfants Malades, Paris, France; Hopital Necker Enfants-Malades, Paris, France, ¶Umea University, Umea, Sweden; #University of Munich, Munich, Germany; **Free University of Amsterdam, Amsterdam, The Netherlands; ††Royal Veterinary and Agricultural University, Frederiksberg, Denmark; ‡‡CHUV University Hospital, Lausanne, Switzerland; §§University of Liege, Liege, Belgium; Medical University of Warsaw, Warsaw, Poland; and ¶¶University of Glasgow, Glasgow, United Kingdom

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children in Europe and, based on these findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children. The Panel concluded on the levels of nutrient and energy intakes that are considered adequate for the majority of infants and young children, and evaluated the risk of inadequate nutrient intakes in infants and young children in living Europe. Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe, and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients. No unique role of young-child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow's milk).

Aflatoxin M1 (AFM1) is a carcinogenic compound found in milk-based products including infant and young children formula. The aim of this study was to determine the risk characterization of infants and young children to AFM1 through the consumption of formula products. For this purpose, the Estimated Daily Intake (EDI) for infants and young children was calculated by multiplying AFM1 concentration in 44 infant formulas, 53 advanced infant formulas, and 16 growing up formulas with consumption data. The concentration of AFM1 in these formula products were retrieved from food registration in Indonesian FDA from January 2015-June 2018. The average concentration of AFM1 in infant formula, advanced infant formulas, and growing up formula (lower bound-upper bound) were 0.0226-0.0335; 0.0418-0.0510; and 0.0038-0.0123 ng/g, respectively. The average EDI of AFM1 for infants and young children aged 0-6 months, 6-12 months, and 1-3 years based on individual consumption were 0.260-0.386, 0.282-0.343, 0.029-0.092 ng/kg body weight (BW)/day. The average EDI of AFM1 for infants and young children aged 0-6 months, 6-12 months, and 1-3 years based on the recommended consumption by food producer (lower bound-upper bound) were 0.403-0.598; 0.663-0.809; 0.031-0.098 ng/kgBW/day. The average hazard index (HI) values for infants aged 0-6 months and 6-12 months (lower bound-upper bound) were greater than 1 (one), i.e., 1.94-2.88 and 3.20-3.90, which indicates there is a health risk. However hazard index value for young children aged 1-3 years (lower bound-upper bound) were less than 1 (one), i.e., 0.15-0.47, which indicates a lower health risk. Keywords: advanced infant formula, aflatoxin M1, growing up formula, hazard index, infant formula

Dietary exposure assessment of perchlorate and chlorate in infant formulas marketed in Shanghai, China

AimThe nutritional quality of foods consumed by infants and young children to complement breastfeeding or formula feeding influences growth and development. The aim of this study was to identify the dietary intake of Indigenous infants and young children in the Gomeroi gaaynggal cohort, and evaluate the nutritional adequacy of their intake compared with Australian recommendations.MethodsDietary intake was assessed using diet recalls at approximately 9‐, 12‐ and 24‐month visits. Nutrient values of foods were obtained from AUSNUT 2011‐13 and nutrient intake compared to the Australian Nutrient Reference Values. Foods were categorised into food groups and intakes compared to the Australian Guide to Healthy Eating.ResultsA total of 206 infants and young children were included in the study. Of these, 95 individual children had dietary data collected between 7.6 and 24.7 months. Infant formula and breastfeeding rates were highest among infants (70% and 20%, respectively). Cow's milk intake was highest among young children (75%).Infants and young children in the cohort met most macro‐ and micronutrient intake recommendations. Few young children met recommendation for iron (42%), no infant met recommendation for omega‐3 fatty acids and almost all exceeded recommendation for sodium. Most young children met daily dairy and fruit recommendations although intake of discretionary foods was high.ConclusionsThis study found that diets of Indigenous infants and young children met most key nutrient reference targets. Potential target areas that require dietary optimisation have been identified and will be the focus of community‐led strategies in adequate infant nutrition promotion.

Iron Requirements for Infants with Cow Milk Protein Allergy

The lessons of noninterventional and interventional prospective studies on the development of atopic disease during childhood.

Quality complementary feeding (CF) of infants and young children is key to their growth and development. But in Jordan, providing appropriate CF remains a challenge. This study assesses trends in infant and young child feeding (IYCF)practices, and consumption by infants and young children aged 6-23 months of breast milk substitutes (BMSs), sugar-sweetened beverages (SSBs), and micronutrient-rich foods in Jordan from 1990 to 2017. We combined dietary data on infants and young children from six Demographic and Health Surveys (DHS)(n = 14,880 children) to compute IYCF indicators. The latter included minimum dietary diversity (MDD),minimum meal frequency (MMF),and minimum acceptable diet (MAD),as well as intake of micronutrient-rich foods and food groups, specific SSBs, and infant formula. We conducted trend analyses using logistic regression models adjusted for child's age in month, child age squared, governorates, urban/rural residence, mother's educational attainment, and household wealth quintiles. We found that the proportion of consumption of micronutrient-rich food groups declined significantly between 1990 and 2017, with fewer infants and young children consuming eggs (OR = 0.39, p ≤ 0.001, 2002 reference), meat, poultry, and fish (OR = 0.25, p ≤ 0.001, 2002 reference), dairy (OR = 0.59, p ≤ 0.001, 2002 reference) and Vitamin A-rich fruits and vegetables (OR = 0.66, p ≤ 0.001, 2002 reference). Conversely, there was increased use of BMSs and sugar-sweetened juices that paralleled a decline in the share of infants and young children meeting appropriate CF practices and consuming micronutrient-rich foods and food groups. By 2017, children aged 6-23 months were significantly less likely to meet MDD, MMF, and subsequently MAD; the odds of consuming BMSs were almost three times the reference (OR = 3.8, p ≤ 0.001, 1990 reference), as werethe odds of consumingsugar sweetened juices (OR = 3.63, p ≤ 0.001, 1990 reference). Food insecurity and undernutrition are low in Jordan; however, overweight and obesity rates are increasing concurrently as are micronutrient deficiencies. This highlights the need for policymakers to address factors at individual and household levels (behaviours and practices) as well as environmental issues (increasing access to unhealthy and ultraprocessed foods).

Baby food pouches are becoming an increasingly popular way to assist the transition from breast milk or infant formula to solid foods, both in New Zealand (NZ) and worldwide. These pouches have overtaken the market in NZ supermarkets, with 63.9% of total baby foods sold in 2021 being in pouch form. While most pouches are aimed at infants, some are pitched to an older age group, and it is possible that some toddlers and preschoolers continue to consume baby food pouches well beyond 12 months of age. Despite concerns raised by a number of health agencies, there has been almost no research undertaken on the use of “baby” food pouches by children, and related health effects. Therefore, this study aims to describe how “baby” food pouches are being used by young children in NZ. In Young Foods NZ, an observational cross-sectional study, 287 participants with children aged 1–3.9 years completed a feeding questionnaire about the child’s “baby” food pouch consumption including frequency, method of use, and setting. The majority (85.4%) of children had used a pouch at some time in their life; however, only 11.1% were current ‘frequent’ pouch users (i.e., used baby food pouches five or more times a week). Sixty-five percent of pouch users always consumed the contents by sucking straight from the nozzle. Chair (22.8%), highchair (25.7%), and while “on the go” (23.1%) were the most common locations where pouches were consumed. Overall, while most young children had tried a “baby” food pouch at some point in their life, relatively few were considered frequent pouch users. These findings suggest pouches are not contributing substantially to most young NZ children’s diets. However, over half of pouch users sucked the contents directly from the nozzle, and this may have implications for dental health and oral motor skill development.

Meeting the Iron Needs of Infants and Young Children

Exposure to high levels of manganese (Mn) in children has recently been associated with adverse neurodevelopmental effects. Current infant formula regulations for Mn content were set between 1981 (United States), 2006 (European Union, France), and 2007 (Codex Alimentarius) prior to the publication of much of the growing body of research on the developmental neurotoxicity of Mn. In this study, we sought to measure the concentrations of Mn in some infant formulas and young child nutritional beverages available on the United States (US) and French markets using ion beam analysis by particle induced X-ray emission (PIXE) spectrometry and then compare the analytical results to concentrations reported in the literature for breast milk and applicable infant formula regulations and guidelines. We were particularly interested in measuring Mn concentrations in product types for which there is very little data from previous surveys, especially soy-based, rice-based, goat-milk based, chocolate-flavored, and nutritional beverages for young children that are not regulated as infant or follow-on formulas (e.g. “toddler formulas” and “toddler powders”). We purchased 44 infant formulas and young child nutritional beverage products in the US and France with varying protein sources (cow-milk, goat-milk, soy, rice) labelled for birth to 3 years. We selected these samples using maximum variation sampling to explore market extremes to facilitate comparisons to regulatory limits. Since this sampling method is non-probabilistic, other inferences cannot be made beyond this set of samples to the overall markets. We used ion beam analysis to measure the concentrations of Mn in each product. The range of measured Mn concentrations in the products is 160–2,800 μg/L, substantially higher than the 3–6 μg/L mean Mn concentration reported in human breast milk. All products satisfied national and Codex Alimentarius Commission (CAC) international standards for minimum Mn content in infant formulas; however, 7/25 of the products purchased in the US exceeded the CAC Guidance Upper Level of 100 μg Mn/kcal for infant formula.

Investigation of the levels of As, Cd, Hg, and Pb in infant and young child formulas and health risk assessment in Türkiye.

Iron deficiency is frequently associated with anaemia. The prevalence of anaemia among Egyptian infants and young children is 25%. Fortification of infant and followup milk-based formulae remains a valuable method for delivering iron to reduce the incidence of iron deficiency anaemia. Percentage of Egyptian non-breastfed children consuming milk or milk products (7-23 months) are 79.1%. No studies have focused on infant and follow-up milk-based formulae that are marketed in Egypt regardingiron fortification and consumption. The objective of the current study was to evaluate the intake of iron by non-breastfed Egyptian infants and young children. To achieve this goal the infant and follow-up milk based formulae brands and types, low – iron and iron – fortified, that are commercially available on the local market were collected. In addition, the iron concentration was determined in the collected formulae in relation to the label statements to ensure the correct intake. Finally, the actual dailyintake of iron from formulae consumption was estimated in relation to the nutritional requirements. The CRM 1846 and 3126a were used for the precision and accuracy of the method. It was shown that the iron levels in all milk-based formulae were lower than those reported on the labels and ranged between 6.17 -10.98 mg/L. No significant difference was found between the average concentration of iron in lowiron formula brands (8.1±2.3 mg/L) and iron-fortified formula brands (8.6± 2.0mg/L). The average levels of the iron in the infant formula brands were lower (p

What Can We Learn from the 2008 Melamine Crisis in China?

Infant formula usage places children at risk for illness and death. Studies in the United States demonstrated high economic burden, health care costs, and absenteeism of caregivers associated with formula usage. Despite high formula usage in developing countries, no economic studies were found. This study examines the financial burden of purchasing infant formula and increased health care expenditure in the Philippines, a developing country with a per capita income of $3930. The average exchange rate of the peso to the US dollar for 2003 was $1 to P52, according to Bangko Sentral ng Pilipinas (BSP). This is a secondary analysis of the 2003 Family Income and Expenditure Survey, a national cross-sectional multistage cluster survey of 42 094 households. Almost half of Philippine families with a young child and one-third of families living on less than $2 per day purchase formula. Nationally, $260 million was spent on infant formula in 2003. Formula-buying families with young children had spent an aggregate of $143.9 million on medical care compared to $56.6 million by non-formula-buying families. After adjusting for income and nonmilk family expenditures, the average formula-purchasing Philippine family spent an additional $0.30 (95% CI: 0.24 - 0.36; r(2) = 0.08) on medical expenditure for every $1 spent on formula. The economic burden from infant formula purchase and out-of-pocket medical expenditure exceeded $400 million in 2003. This cost was aside from other costs, such as absenteeism and the risk of childhood death and illness. These expenses caused an unnecessary burden on Filipino families and could instead have been invested in education and other social services.