‘A call to arms’: Infant nutrition cereals failing to meet standards in low income countries

By Gary Scattergood contact

- Last updated on GMT

Researchers say basic quality assurance services are needed to reduce childhood malnutrition. ©iStock
Researchers say basic quality assurance services are needed to reduce childhood malnutrition. ©iStock
An analysis of more than 100 locally-manufactured premixed infant cereals from low and middle income countries, including Indonesia, China and Nepal, has revealed widespread variation in nutritional content, sparking concerns they could contribute to micronutrient deficiencies.

In Asia and Africa, premixed flours for infant porridge are increasingly being produced by local firms to complement breastfeeding.

“Such complementary food products have known efficacy against malnutrition in children from six to 24 months of age, but ingredient ratios and production processes may vary. This study provides the first systematic measurement of their actual nutrient composition,”​ wrote researchers in the journal Maternal & Child Nutrition.

They purchased samples of 108 premixed CF products in 22 low and middle-income countries, and commissioned blind laboratory measurement of each product's macronutrients and micronutrients.

Products included in the study were explicitly marketed as composite flours made with more than one ingredient, to be boiled with water and served as porridge to infants after six months of age.

Researchers excluded any products manufactured in high-income countries, and also excluded any infant formulas to be served in liquid form. Almost all of the sampled products were locally made by small and medium-scale millers, which also sold other packaged cereal products

“We compared measured contents to nutrient claims on their packaging and to CF standards from the Codex Alimentarius, the Super Cereal Plus product used in nutrition assistance programs, and the Lutter and Dewey (2003) recommendations, as well as our own modelled nutrient requirements for a healthy breastfed child,”​ they wrote.

Only 15% of samples met two of the three benchmarks for fat, 32% met the most stringent protein standard, while only 22% met them for iron, and 21% for zinc.

“The median healthy child consuming breast milk plus enough of these solid foods to meet energy needs would experience deficits of zinc at 6 months, iron at 6 and 9 months, and dietary fat from 12 months of age.”

The researchers, from the Friedman School of Nutrition Science and Policy at Tufts University in the US, stated that basic quality assurance services are needed to improve trust in these products and help reduce the incidence of childhood malnutrition in lower-income countries.

Comparing nutritional content to claims on packaging labels, fewer than half of the products met their reported caloric content. Slightly more than half misreported protein, and two thirds misreported fat content. For zinc and iron, products exceeded labelled values about as often as they fell short.

Below requirements

"Premixed complementary foods can be extremely effective at protecting infants against malnutrition and stunted growth. In countries where we sampled, some products can readily meet children's needs, but others fall far below requirements for both macro and micronutrients,"​ said study author William Masters, food economist and professor at the Friedman School.

"Our results are a call to action for establishing and enforcing nutritional quality standards, which would help ensure access to lower-cost, higher-quality products and enable parents to meet their infants' needs more easily."

Nearly half of all deaths in children under age five are related to undernutrition, which is particularly widespread in Africa and Asia, according to UNICEF.

Masters added there was a considerable gulf between the nutritional standards set by multinational brands and local products. "This is a category of foods which can be lifesaving, but the market for locally made foods with the same nutrients as multinational brands is almost non-existent. Why aren't store shelves full of competing, low-cost infant cereals made to uniform standards from local ingredients? Their potential cannot be fulfilled until parents trust them to have the nutritional contents they claim.”

Source:  Maternal & Child Nutrition

DOI: 10.1111/mcn.12421

"Nutrient composition of premixed and packaged complementary foods for sale in low- and middle-income countries: lack of standards threatens infant growth." 

William A Masters, et al.