Out of 212 commercially available infant formula milk products for infants under three, the study finds over half contains more than five grams (g) of sugar per 100 millilitres (ml).
In many cases, the sugar content was over 7.5g per 100ml, which exceeds European parliament recommended levels for infants.
“For example, we found that a powdered product for infants under six months sold in France contained 8.2g of sugar per 100ml, or nearly two teaspoons, says Gemma Bridge, lead study author from Leeds Business School at Leeds Beckett University.
“A ready-to-drink milk formula for infants under 12 months sold in the UK contained 8.1g of sugar per 100ml.”
“The source of sugar in formula milk is not clear,” she adds. “In some instances, sugar content is not even written on the labels. Also, breastmilk sugar content changes daily based on the energy needs of the infant. Formula milk does not.”
Study criticisms
The study was not without its detractors though as critics took to Twitter to point out issues with the choice of infant formula included in the methodology.
“[The paper] seems to have included supplementary milk drinks aimed at toddlers (including pediasure),” says Dr Ruth Ann Harpur, clinical psychologist at the South London and Maudsley NHS Foundation Trust.
“These aren’t infant formulas. From what I can see the sugar content of infant (i.e. under 12 months) is comparable.
“Also included is arlo big milk which is just cow’s milk with added vitamins D & A and iron... funnily enough you don’t mention that this has less sugar than infant formulas and breastmilk for that matter.
“By lumping products that aren’t infant formulas in with infant formula & declaring it to have more sugar than fizzy drinks, [the study] risks adding to the confusion some parents feel about choosing an infant formula and the perception of formula as an unhealthy food choice.”
Along with colleagues from the University of Geneva and Kings College London, the exploratory study collected a sample of infant formula products available in 11 countries.
The sample included commercially available formula products (sample size - 257) targeted at infants aged below three years of age.
Products collected were available from 33 different manufacturers under a variety of different brand names with ready-to-drink products in the analysis only available in the USA, UK and Switzerland.
Carbohydrates as sugars
The results found carbohydrates of which were sugars (g/100 ml) were not listed separately on all products.
Where it was listed, carbohydrates of which sugars ranged from 1.1 (milk formula powder for under 6 months, UK) to 9.8 (milk formula powder for 12 months and over, USA). Average sugar content was 5.9 g/100 ml across the products sampled.
Products targeted at infants over 12 months had higher average carbohydrates of which sugars content (7.03 g/100 ml) than formula milk powder targeted at infants under 12 months.
The widest range and the highest total content of carbohydrates of which sugars was observed in products from the USA (6.8-9.8 g/100 ml).
The study also highlights the inadequacy of the product’s label information with the team pointing to the small fonts used and the inconsistency in presenting facts from country to country.
Examples include some products listed sugar content per 100g while others listed it per 100kcal. This is despite UK guidelines, which states that values should be expressed as kJ/kcal per 100ml.
“The aim of the study is not to make mums feel guilty about their feeding choices,” says Bridge. “Instead it is to advocate for labelling transparency so parents can make informed choices and to encourage policy makers to consider sugar/ ingredient regulation.”
Series of recommendations
In making recommendations, the study calls for tighter regulation that controls the amount and type of sugar in infant formula products.
Its authors also want to see manufacturers aim for formulations as close to breast milk as possible with corresponding regulations conducted in a similar way to the taxes on sugar-sweetened beverages.
Finally, the research team calls for mandatory disclosure of added sugar by manufacturers, with this action implemented alongside the introduction of a clear front-of-pack labelling system.
According to the researchers, these disclosures and labelling could aid consumers to make informed choices about what products they purchase.
Source: British Dental Journal
Published online ahead of print: doi.org/10.1038/s41415-020-1252-0
“A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants.”
Authors: Gemma Bridge, Marta Lomazzi & Raman Bedi