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What is already known on this topic
Complementary solids are recommended from age 6 months, in order to move an infant from a milk-based diet to a family foods-based diet, thus introducing flavour, texture and diverse nutrient dense foods to the diet. Commercial infant foods are widely used by parents when commencing solid feeding.
What this study adds
Many products are targeted at infants from age 4 months, and a majority of such foods are sweet. Most products are ready-made spoonable foods that are no more energy dense than formula milk, and are generally much less nutrient dense than homemade foods.
The introduction of complementary foods (also known in the UK as ‘weaning’), is the transition from a purely milk-based diet to a diet that contains solid foods. Health professionals are frequently asked to advise on aspects of complementary feeding, and thus, need to understand their nutritional content. The UK Department of Health (DoH) recommends that the transition to complementary foods be gradual, introducing first cereals, vegetables and fruits, followed by protein-rich foods.1 ,2 This is particularly important to replete iron stores in exclusively breast-fed infants.3 ,4 Infants need to be exposed to a variety of tastes, flavours and textures to allow them to learn to accept different foods,5 ,6 although salt and sugar intake should be limited.1 ,2 Home-prepared foods are recommended to introduce the infant to a greater range of culturally appropriate flavours, tastes and textures, but commercially produced complementary foods are widely used in the UK. In a 2010 survey, 2/3 mothers gave commercial products (predominantly baby rice) as their first solid food, and 45% of mothers of 8–10-month-old babies were still using commercially prepared foods at least once a day,7 This highlights the central role the commercial infant food market plays in shaping babies’ diets8 ,9 and the importance of understanding the type of commercially prepared infant foods available. The aims of the study were to describe the types of commercial infant foods available in the UK market, summarise their nutritional content and compare this to family weaning foods.
Information was sought on all infant foods produced by the four main infant food manufacturers in the UK during the period of October 2010–February 2011, as identified by products sales in Key Note market research10: Cow & Gate (115 products), Heinz (103 products), Boots (50 products), Hipp Organic (115 products), as well as two smaller firms producing organic products: Ella's Kitchen (38 products), Organix (58 products). Products included ready-made (soft, wet) foods and dry foods to be reconstituted with either milk or water (cereals, cakes, biscuits, rusks, bars, snacks and raisins). Products were packed in jars, sachets, boxes, plastics, pots, cans, or bags; all baby drinks, smoothies and milks were excluded.
Nutritional information for each product was collected from manufacturer's websites and in the case of Boots, from the products in store. A database was collated with information on general descriptors (product name, recommended age, type of liquid recommended for dilution (milk or water for dry products), added salt or sugar and nutritional content which included: energy (kcal, kJ/100 g), protein, carbohydrate, sugar, fat (g/100 g); iron and calcium (mg/100 g). Iron and calcium levels were found on brand websites for Heinz and Hipp Organic, while Cow & Gate provided information following an email request. The three remaining brands, Organix, Ella's Kitchen and Boots do not fortify their foods with vitamins and minerals, and did not provide micronutrient values for their products. Manufacturers of organic foods are not allowed to add micronutrients.11
Analysis of data
Using the name and product description, products were classified as sweet or savoury and into four major food types: ready-made, breakfast cereals, powdered meals that needed reconstitution and dry finger foods such as rusks. Where there was doubt, further information was obtained from supermarkets and manufacturers or by examining products in shops. Sweet products were classified by fruit content (sweet fruit only, sweet containing fruit and sweet without fruit). Savoury products were classified as: containing meat or fish, vegetarian and dry snacks. For the purpose of this paper, the term ‘texture’ refers to soft, wet, ready-made (‘spoonable foods’) and dry finger foods, while ‘taste’ refers to sweet and savoury products. Savoury containing meat products were all products that specified in the name red meat (beef, lamb, pork including sausages and bacon), poultry or fish. Other savoury products included vegetable, cheese and pulse only dishes or carbohydrate-based dishes (eg, rice, pasta, potatoes) or a combination of those. If the name of the product referred to meat, fish or cheese, or had two or more vegetables in the list, but also included one fruit among other ingredients in the name, we considered them as savoury.
All nutritional analysis was per 100 g product. The products were compared to the typical nutritional composition of breast milk,12 ,13 and the average for baby formula milks based on values reported for first and third stages of four commercial brands (SMA, Aptamil, Cow & Gate and Hipp Organic). Cereals and dried products needing reconstitution with either milk or water were excluded from the nutrient content analysis, due to the difficulty of defining the nutritional content and volume of the diluents.
The ready-made products were also compared with the nutritional content of examples of UK family homemade foods commonly used for infants and toddlers. Mince meat and chicken are important dietary sources of protein and iron in the British diet.14 White bread and mashed potatoes are recommended as first foods.15 Vegetarian meals similar to those recommended in First Fun Foods15 were included. Stewed apple, rice pudding and custard are UK desserts traditionally given to infants. The nutritional content of family foods was based on McCance and Widdowson food tables (5th edition) obtained from the software WinDiets (Robert Gordon University, 2010).
All statistical analyses were done using SPSS V.19 data software (SPSS, Chicago, Illinois, USA).
Of the 479 products identified in this study nine were baby pastas and eight pasta sauces which were not designed to be served as individual dishes and were thus excluded from further analysis, leaving 462 products. Of these, 364 (79%) were ready-made (soft, wet) mostly baby jars or sachets, 45 (9%) were dry finger foods and snacks, such as rusks, biscuits, bars, crisps and baby raisins. There were 52 (11%) dry products designed to be made up with either milk or water: 45 baby cereals including four pure baby rice products and seven other powdered foods considered as whole meals; for reasons outlined above these were excluded from nutritional analysis, leaving 410 products.
Commercially produced infant foods are grouped by recommended age groups, 4+, 6+, 7+, 10+ and 12+ months. Nearly half the products (44%) were targeted at 4+ months age and 65% of foods in this category were classified as sweet (table 1). Ready-made (soft, wet) products were available in varying portion sizes from 120 g to 250 g. The serving size of finger foods and snacks ranged from 5 to 50 g.
A third of sweet products were either breakfast cereals or biscuits and rusks, with the remainder being spoonable foods. The majority of sweet products (80%) included fruit in the name description: a third of these consisted of fruit only, but for the rest the exact amount of fruit included was not stated. Sweet products that include the words dessert, pudding or crumble in the name represented 23.8% of the total. Other food types included dairy-based infant foods, such as yogurt and custards (20.2%), breakfast cereals (22%) and dry snacks, cakes, bars, ‘brekkies’, rusks, biscuits and raisins (14.3%). There were 30 (5.8%) products (24 made up spoonable foods and six dry finger foods) whose label stated they contained added sugar, but 109 (26.6%) products had a total sugar content higher than 10%, which suggests fructose was the main contributor to total sugars.
The great majority of savoury foods (92.5%) were soft, spoonable, starch-based meals (which included rice, pasta, potatoes, or cous-cous) and 64.6% contained at least some meat, fish or poultry. Most savoury foods included at least one vegetable in their name while 19 (8.5%) also had added fruit. Two products (0.5%) stated in the label to contain added salt.
The nutritional content of commercial infant foods is shown in table 2 with comparison values for the typical nutritional content of breast milk and average content of various brands of formula milk. Ready-made (soft, wet) foods showed a remarkable similarity in energy content to formula milk, while their protein content was only around 40% higher. The sweet spoonable foods had higher sugar levels than the savoury foods, which had higher protein content. Although meat containing savoury foods had the highest iron content, this was no higher than formula milk, and not much higher than non-meat-containing foods. Milk-based products had the highest calcium content. The sodium content was higher than for formula milk, but levels were still very low. As expected, the dry finger foods had a much higher energy and nutrient density overall, with particularly high sugar content.
The savoury ready-made spoonable foods generally had much lower nutrient density than the sorts of family food that might be given to an infant aged 6–12 months (table 3) with the exception of iron content. This meant that around 50 g of a soft spoonable family food might supply the same amount of energy and protein as 100 g of ready-made spoonable food. Even the vegetarian family foods were at least 50% more energy dense, with the exception of one dish made mainly with vegetables, with no added butter or cheese. The ready-made spoonable sweet foods had similar energy density to the example home-cooked sweet family foods, but had lower protein. Commercial rusks and biscuits were much more energy dense and contained high amounts of iron and calcium, but also tended to be high in sugar.
This study demonstrates the large number of commercial infant foods available in the UK market for different age ranges and describes their main characteristics and nutritional content. This cross-sectional survey is the first report aiming to summarise the variety and nutritional characteristics of infant foods and to critically review how these foods conform to new weaning recommendations. The large number of products made it impossible to record the exact ingredients for each food so the classification of food types relied on the name of the products. However, it is these names that will induce parents to select one product over another. We cannot comment on the actual texture or taste of the foods, but hope to do so in future studies. We were unable to produce robust estimates of the nutritional content of the reconstituted dried foods, due to uncertainty about the volume and type of diluent, but in fact these made up quite a small proportion of all products. Our data relies on manufacturers’ reported nutritional information, so may not reflect actual nutritional content, however, a recent study in a sample of infant foods in the UK suggest that the macronutrient content reported by manufacturers reflect the declared values.16 We compared the commercial weaning foods with typical family foods commonly given to children in the UK as complementary foods. We could select only a few family foods, but these were all common, widely available combinations of ingredients.
WHO recommendation in 2002 to defer solid feeding until 6 months was a pragmatic guidance that balanced the evidence on the risk of complementary solids, both directly and via the displacement of breast milk, against increasing infant requirements for energy and other nutrients.17 The DoH adopted that recommendation in 2003, also stating that solid foods should never be given to babies under 17 weeks.1 ,2 Premature introduction of solid foods has long been a concern in the UK, and following the change in recommendations, the proportion of infants introduced to solid foods before 4 months of age dropped from 51% in 2005 to only 30% in 201018 and similar trends have also been reported in the USA9 and other European countries.19 Despite this, 43% of infant foods were labelled as being suitable ‘from age 4 months’ which, while compatible with the EC Directive that ‘the stated age shall not be less than 4 months for any product’,20 seems likely to offer encouragement to introduce complementary foods before 6 months.
Two-thirds of the commercial foods targeted at the youngest infants were classified as sweet. An innate preference for sweet foods in babies is well established6 which may explain why sweet ingredients are more likely to be used to make complementary foods more palatable. However, repeated exposure to foods during infancy promotes acceptance and preferences.21 High sugar intake at age 3 years old is associated with dental caries at age 6.22 Thus, weaning guidelines recommend offering complementary foods without added sugars ‘to set the infant's threshold for sweet and salty tastes at lower levels later in life’.2 These commercial foods appear to adhere to this recommendation by using foods rich in fruit sugars (fructose), rather than added sucrose, but both are probably equally cariogenic in process form.23
A main purpose of complementary solids is to increase the energy content of the diet and provide richer sources of particular nutrients such as iron. Yet the most commonly used commercial foods considered in this study supply no more energy than breast or formula milk. This similarity may be due to the EC Directive regulations and how food manufactures have to adhere to them.20 Mothers often justify introducing foods earlier than 6 months as they feel their babies are hungry24 and health professionals should be able to advise mothers that first-stage commercial baby foods are no more energy dense than milk.
Surprisingly, the iron content of the majority of ready-to-eat infant foods is lower than the iron content of infant formula. This seems to be the case even in foods listed as containing meat, and their low protein density suggests that the proportion of meat in the product must be low. This may be due to the fact that regulations limit the amount of added meat allowed.20
As the age of weaning has risen in the UK, the development readiness of infants at the point of weaning will be greater. In one UK survey, 40% of babies were reaching out for foods by the age of 6 months,25 suggesting that infants should soon be able to progress to foods prepared for the whole family, with minor adaptations such as mashing or cutting into small bite-size portions.26 This may be important, as delaying the introduction of lumpy foods beyond 10 months has been associated with feeding difficulties27 and refusal to accept foods later in childhood.28 Home weaning foods need to be prepared differently from family food: salt and sugar should not be added and inappropriate adaptation of family meals to weaning foods may contribute to a high sodium intake.29 However, there are many leaflets, books and government websites advising parents on the preparation of weaning foods, and some districts also run weaning fairs and cooking demonstrations for new parents.
Commercial infant foods are widely used in the UK, but they mainly supply soft, spoonable foods, half of which are sweet, and are aimed at infants from age 4 months. While it is understandable that parents may choose to use commercial foods early in the weaning process, health professionals should be aware that such food will not add to the nutrient density of a milk diet, and when advising families, should encourage them to progress to suitable family foods, particularly later in the first year of life.
We are grateful to the food manufacturers for answering queries and supplying missing information, and to Pauline Emmett for her detailed comments on an earlier draft of the manuscript, and for supplying portion-size information for this age group.
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
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