Busy parents are constantly trying to make the best choices they can regarding nutrition for their children. However, this is extremely difficult due to misleading food products that claim to be healthier than they are. In the US, there are currently no nutritional or promotional guidelines for infant and toddler convenience food products. In a recent study published in the Open Access journal Nutrients, researchers found that 60% of infant and toddler foods in the US fail to meet the nutritional requirements of the nutritional and promotional profile model (NPPM) set by the World Health Organisation (WHO) Regional Office for Europe in 2022.

This is extremely concerning, as certain food groups fuel the rapid growth infants undergo during early childhood.  A balanced diet packed with a wide variety of food groups is fundamental for healthy growth and development as well as for forming healthy food habits in the future. The US Centres for Disease Control and Prevention reported that 1 in 5 U.S. children and adolescents have obesity. It’s well documented that the overconsumption of sugars and sodium can result in obesity and related diseases.

In this article, we explore the shocking evidence identified in this article and the implications of this research.

What is the WHO nutritional and promotional profile model?

The WHO defines nutrient profiling as:

“the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health.”

The NPPM was created by the WHO’s Collaborating Centre in Nutritional Epidemiology at the University of Leeds in 2019. It was developed in response to international concerns about the nutritional value of some convenience food products for infants and children sold across Europe. As convenience foods continue to increase in popularity, it’s important to be vigilant about infant diets and the contents of these snack foods, such as fruit purees. In addition, there are a range of products that are advertised for babies under 6 months. This is against the WHO guidelines of introducing food at 6 months.

The concern with introducing food too early to babies is that the food replaces breast milk, which still provides a wide range of essential nutrients for this age group. Furthermore, replacing this nutrient source with foods with little nutritional gain is worrying.

“Early childhood is a crucial period of rapid growth and when taste preferences and dietary habits form, potentially paving the way for the development of chronic diseases such as obesity, diabetes, and some cancers later in life,” – Dr. Elizabeth Dunford, author of the paper.

“Time-poor parents are increasingly choosing convenience foods, unaware that many of these products lack key nutrients needed for their child’s development and tricked into believing they are healthier than they really are.”

How does the WHO nutritional and promotional profile model work?

The NPPM gives the user a framework to evaluate the nutritional gain of food products and generate evidence against unsuitable products. This evidence aims to influence positive changes in the production and composition of certain food products and their marketing to protect the nutrition of infants and children.

The model breaks products down into eight broad food categories:

• Dry cereals and starches
• Dairy foods
• Fruit and vegetable purees/smoothies and fruit desserts
• Savoury meals/meal components
• Combinations of starches
• Vegetables
• Dairy, and/or traditional proteins
• Snacks and finger foods
• Ingredients
• Confectionery
• Drinks

Furthermore, the food products are then broken down into subcategories; for example, dairy has two subcategories: dairy products with cheese and dairy products without cheese. The food products are then assessed using relevant nutrient composition standards for their subcategory and evaluated.

Using the WHO NPPM to evaluate US food products

The researchers from the US, Australia, and Brazil used this model to assess the nutritional value of infant and toddler convenience foods. They collected infant and toddler food from the ten grocery chains in the US. The researchers analysed 651 products marketed towards children aged 6-36 months. Furthermore, they also assessed the type and number of claims across the packaging.

Nutritional value of infant foods in the US

The researchers identified that of the 651 products assessed, 60% of these failed to meet the nutritional requirements of the NPPM. Additionally, they identified that 70% of the products failed to meet the protein requirements and 44% exceeded total sugar recommendations.

Overall, the researchers found that snack-size packages had the lowest compliance with nutrient requirements. This includes products such as fruit bars, cereal bars, and puffed snacks, which account  for up to 20% of products available to purchase. They contained low levels of protein and high levels of energy, sodium and sugar, free sugars, and sweeteners.

Furthermore, none of the products met the promotional requirements. In addition, almost 100% of products had at least 1 claim on-pack that was prohibited under the NPPM. Furthermore, some products had up to 11 prohibited claims.

“The lack of regulation in this area leaves the door wide open for the food industry to deceive busy parents,” – Dr. Daisy Coyle, author of the paper.

“We saw this not only in the use of misleading claims but also in the use of misleading names, where the product name did not reflect the main ingredients found on the ingredient list. For example, snack and finger foods often refer to fruit or vegetables in the product name, despite primarily being made of flour or other starches.”

The researchers also analysed the nutrient composition of fruit and vegetable pouches. They found that pouches had experienced 900% growth in the market over the last decade. They now represent 50% of products available in the toddler and infant sector. This is a big concern as the study found that only 69% of pouches met the NPPM standards for total sugar.

Future implications for infant and toddler food

The researchers uncovered some very concerning findings on toddler and infant convenience food products. They identified that no commercially produced infant and toddler food products available to purchase in the US met international standards for both nutrition and product promotion. The analysis showed that the products contained high levels of sugars and free sugars.This is the primary cause of obesity. In addition, consumption of high levels of sugar has also been linked to related diseases such as diabetes, heart disease, and some cancers.

Some of the most vulnerable and impressionable members of our society are consuming food advertised as healthy, which has the potential to be harmful. The researchers hope that this study will demonstrate that change needs to happen. Also that policymakers need to act to stop these products from entering the market. Furthermore, manufacturers need to produce healthier alternatives to replace unsuitable foods. Additionally, they note that the use of misleading claims on packaging needs to be regulated so that carers can make informed choices.

“Our findings highlight the urgent need for better regulation and guidance in the infant and toddler foods market in the United States—the health of future generations depends on it.”- Dr. Dunford

If you would like to read more about paediatric nutrition or would like to submit research in this area, please see the section Pediatric Nutrition.