Which International Guideline for Regulating the Composition of Formula Milk Can be Applied in Iraq

Abstract

Background: Formula milk is commonly used for feeding infants in Iraq; yet, no specific Iraqi national guideline present to regulate the importing and marketing of such types of milks, so this study aimed to find out a best international guideline that can be adopt as the Iraqi national guideline for importing and marketing of safe and optimum formula milk. Methods: A web search for the available international guidelines that control and regulate the composition of formula milks was done using the following keywords: formula milk, nutritional, composition, and guideline, through pubmed and Google websites. Five major guidelines were found: the codex Alimentarius commission, Food and Drug Administration (FDA) guideline, The Life Sciences Research Office (LSRO) of the American Society for Nutritional Sciences guideline, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline and the European food safety authority (EFSA) guideline. A comparison between these guidelines was made and based upon the following criteria's: the date of release, the date of most recent update, the mandatory and optional ingredients, and the proposed minimum and maximum limit of each nutrient. Results: EFSA guideline is the most recent one, which mention both the minimum and maximum required level of all macro and micronutrients. Maximum limit for most of micronutrient is not mentioned by both the Codex and the FDA guidelines. There are many micronutrient contents are not mentioned by FDA guideline. The minimum required level for most of macro and micronutrients are similar between Codex Alimentarius and ESPGHAN guidelines, however the maximum limit of most of these contents are not stated by the codex guideline. LSRO guideline is the most different guideline with regard to minimum and maximum required level of both macro and micronutrients when compared to all other guidelines. DHA is a mandatory component by EFSA guideline only. The maximum limit for ALA is set only by EFSA guidelines. Furthermore the minimum requirement of Na, Cl, K, Se, I, Folic acid, Vitamin D, niacin and choline are higher in EFSA guideline than that in all other guidelines. The minimum requirement of vitamin C, Vitamin K, B2 and B6 are lower in EFSA guidelines than all other guidelines. The maximum accepted level of protein and niacin in EFSA guidelines is lower than that of all other guidelines, while the maximum accepted level for B6 in EFSA guideline is lower than that in all other guidelines except for LSRO guideline. Conclusion: EFSA guideline is the most suitable guideline to be applied in Iraq to ensure marketing of safe and nutritionally adequate formula milk.