Background: The premature consumption of processed foods with high sugar and sodium content over the course of life has been associated with an increased risk of suffering from chronic diseases starting in adolescence or early adulthood. Methods: There was an examination of the nutritional labelling of processed products for young children (n = 140) available in the Honduran market to evaluate their nutritional quality with regard to sodium and sugar content, pursuant to various international recommendations. Results: 54% of the products evaluated derive more than 20% of their calories from sugar. The categories that to a large degree exceed the recommended sugar content range are fruit drinks (80%) and dessert purees (65%). The average price per product serving is lower than one US dollar ($0.81). 46% and 6% of the products place sugar and salt, respectively, among the first five positions in their ingredient lists. Conclusions: Processed foods for infants and young children generally exceed the recommended sugar content, but due to their low cost and easy access, they are displacing traditional food consumption, contributing to increasing childhood obesity and chronic disease in the early stages of life.
Complementary feeding includes the transition period in which an infant (a lactating child up to one year old) transits from exclusive breastfeeding (EBF) to share the family diet [
The first two years of life represent the period of greatest importance to establish the foundations of healthy eating habits by ensuring the acceptance of foods rich in nutrients like fruits and vegetables [
As a result of globalization and technological progress, there has been a nutritional transition on an international level characterized by lower dietary fiber consumption and an increase in the intake of salt, fats and simple sugars from processed and ultra-processed food [
As a result of the failure to comply with these recommendations, on a worldwide level there are four million children under five years old suffering from obesity [
Despite this situation, there are no national or international laws to regulate the critical nutritional contents (sugar, sodium, fats) of baby food [
In some countries, such as Honduras, nutritional labelling is not obligatory, nor are there regulations or specific recommendations for regulating baby food production and marketing to ensure the welfare of infants and young children.
With respect to sodium content, the Codex Alimentarius recommends that children’s products have a limit of 200 mg of sodium per 100 g of product [
For their part, WHO and UK National Diet and Nutrition Survey recommend a simple sugar content of under 10% of the calories by serving and under 5% for additional benefits [
In the absence of an international agreement on recommendations for sodium and sugar content and the wide range of baby foods marketed, particularly in Honduras, which is an importer of processed foods, it is important to assess products intended for infants and young children available in the country’s main supermarket chains and retail stores. Because such products influence the growth and development of this population group in the medium and long term, the goal is to study the nutritional quality of products that are offered, pursuant to the different international recommendations.
An exploratory descriptive study was conducted based on a review of the nutritional labels of processed and ultra-processed foods (hereinafter referred to only as processed) for children offered in Honduras, identifying products by whether or not they comply with the limits for sodium and sugar content established by the different international agencies.
The study was conducted at the Zamorano University (EAPZ) Human Nutrition Laboratory. A number of supermarket chains were selected in the two main cities of Honduras (Tegucigalpa and San Pedro Sula), all with national presence and covering different socio-economic sectors of the market. Similarly, retail outlets open to the public were included order to have both levels of marketing. Repeated products were not included.
The visits were made by personnel appropriately trained in information harvesting in two stages: from June to October 2017 and from July to September 2018. The only inclusion criteria for the study was to take into account all the available foodstuffs on store shelves for lactating babies and small children, without distinction, with labels recommending that they be administered to small children. The product container and nutritional labels were photographed to capture the main nutritional content data, manufacturing data, ingredient list and price. The number of ingredients was identified according to the corresponding list, considering vitamins (any) as one ingredient and minerals (any) as another ingredient. Infant formulas and foodstuffs aimed at children older than 36 months were excluded. There was no internet search for products, because it was preferred to find them at the different points of sale to ensure their availability in the Honduran market; this is the first such study in this area.
The Codex parameters specific to the category of cereal-based baby food (100 mg/100kcal) [
The Codex parameters (7.5 g/100kcal) [
Likewise, there was an evaluation of the presence of salt and sugar (or another type of sweetener) in the ingredient list, with an emphasis on products where these are among the top five positions. The sodium and sugar content in baby foods was evaluated per serving. Based on this information, an Excel 2016 (Microsoft, Redmond, WA, USA) database was prepared with the product name, target age range, manufacturer, manufacturer’s country, price, ingredients, serving (g), sodium (mg), sugar (g) and energy (kcal), to make a comparison using the aforementioned criteria and estimate the caloric density, 1:1 ratio of sodium: kilocalories and price/serving. Descriptive measures, specifically frequency distribution tables were used for the data analysis. The baby foods were organized into five categories (
A total of 140 products were evaluated. 70% of the products were purchased from Tegucigalpa and the surrounding area (n = 98). Once the products were listed, to avoid repetition the remaining 30% were acquired at points of sale in San Pedro Sula (n = 42). The products came from seven countries, mostly from
Product category | Average sodium (mg/serving) | Calories derived from sugar per serving (average percentage) |
---|---|---|
Fruit drinks (n = 10) | 12.6 | 87 |
Dessert purees (n = 54) | 11.1 | 75 |
Snacks (n = 29) | 24.7 | 33 |
Yogurt (n = 10) | 36.0 | 53 |
Fruit snacks (n = 2) | 6.0 | 34 |
Cookies/Biscuits (n = 11) | 9.5 | 21 |
Corn Snacks (n = 6) | 40.0 | 0 |
Dinner purees (n = 17) | 33.5 | 28 |
Cereal based foods (n = 30) | 28.4 | 21 |
Total sample (n = 140) | 20.7 | 45 |
the United States (58%), followed by Mexico (19%). 12% of them were from South American countries and the remaining 10% from Central American countries; 1% was of European origin. There were no products manufactured in Honduras.
A total of 18 companies were identified that market their products in the country. The largest number of products were manufactured by Gerber Product Company (39%) of US origin, followed by Nestle of Mexico (16%) which produces the brands Gerber and Nestum. 11% of the evaluated products are produced by Beech Nut Nutrition Company also of US origin, whereas 34% of remaining products were made by 15 companies, among them Irex from Costa Rica, Nutrimental from Brazil and Gourmet from Guatemala.
The majority of products and all the categories represented, were aimed at the consumption of infants from 6 months of age (73%), followed by products aimed at children older than 12 months (12%) in the categories mostly of snacks and dessert purees, followed by cereal-based foods. Some products (6%) were identified as promoted for consumption at 4 months (Beech Nut from Chile and Gerber from the US), specifically in cereal-based food categories, dinner purees and snacks.
In 140 products grouped in the five mentioned categories, that of dinner purée had the highest average sodium content (33.5 mg) per serving, followed by cereal-based foods (28.4 mg), while all the categories had elevated sugar-derived calorie content per serving. Fruit drinks presented the highest average sugar-derived calorie content (87%), followed by dessert purees (75%), as can be seen in
The category of snacks presented high values for the content of one or both of the nutrients. In this same category, corn snacks had the highest sodium content in the whole sample (40 mg) and yogurts had high sugar-derived calorie content (53%) and sodium (36 mg) levels above the respective average.
The average number of ingredients in products in the different categories and subcategories varied from three (fruit snacks) to 14 (cookies/biscuits), followed by corn snacks (12) and yogurt (12), according to the corresponding listing. Thus, the category of snacks had a higher average number of ingredients (10) than the rest: (4) fruit drinks, (7) desert purée, (6) dinner purée and (7) cereal-based foods.
With the exception of cereal-based foods, none of the products evaluated exceeds the limits established by Codex, USDA, FDA and IOM, since the maximum amount of sodium found was 146 mg. According to FDA criteria, 97% of the products were evaluated as acceptable, low in sodium or without sodium. The remaining 3% of evaluated food did not indicate its sodium content, representing four products in the dessert puree category, manufactured by the Heinz Company from Mexico.
Additionally, according to the specific criteria established by the Codex to regulate sodium content of cereal-based foods, 3% of products in this category, specifically the Nestum and Nutribom brands exceeded the recommendation of >100 mg/100kcal per serving.
Six percentage of total products in the sample, list sodium among the first five positions in the ingredient list. This was mainly observed in the snacks category (47%), with 100% of corn snacks and 30% of yogurts presenting this characteristic.
A review of sodium content per calorie contribution identified that 17% of the products in the categories of dinner purée and 2% of dessert purees, exceeded sodium content of PAHO recommendations as well as 67% of corn snacks, the majority of which had a 1 mg sodium: 1 kcal ratio or excess sodium.
Of the 10 products with highest sodium content (
yogurt subcategory and the rest were in dinner purees, dessert purees and one corn snack. All of the products are designed for infants from 6 months of age.
According to the criteria of the WHO and AHA, 54% of the evaluated products are high in sugar, with more than 20% of their calories derived from it; 7% complied with the recommendations of WHO and the UK National Diet Survey with less than 10% of calories from sugar; 3% complied with WHO recommendation about the additional benefits of products with less than 5% of calories from sugar. 22% of the products in the sample do not refer to the added sugar content among total carbohydrates.
In cereal-based foods and according to the CODEX, 10% of this type of food exceeds the established content for sugars, whereas 60% complied with the recommendation. 30% of the remaining products did not report the amount of sugars in total carbohydrates.
However, 46% of total products mentioned sugar or brown sugar among the first five positions in the ingredient list. The snacks category showed the largest number of products with this characteristic (52%), mainly the cookies/biscuits subcategory (82%), followed by the cereal-based food category (50%) (
Although the fruit drink category has the highest percentage of sugar-derived calories, they are not mentioned in the ingredient lists because there is no breakdown of the ingredients in the fruit concentrate referred to in the list. However, the amount of sugar is indicated in their nutritional labeling per serving. It is for that reason that
The energy density (ED) of products ready for consumption, by category and according to the recommended age, varies from 0.96 kcal/g for babies of 4 months of age, to 1.27 kcal/g for 6 to 12 months and 2.12 kcal/g for over 12 months of age. By category, as can be seen in
Foods by full container, from lowest to highest price, were the dessert purees ($0.92), dinner purees ($1.84) and cereal-based foods ($3.61). The cost per serving (
Despite the numerous benefits of EBF, the number of infants who eat any type of food before 6 months of age continues to increase. Concerns and misinformation of parents and contradictory messages from advertising media and unethical health professionals contribute to the decline in the percentages of EBF [
aExchange rate to L. 24.10 (Central Bank of Honduras) [
age for consumption of their products, when food intake at this age should be the exception and not the norm [
The market for this type of products is very broad, with a wide range of processed products aimed at infants and young children [
During the 2000-2013 period, sales in Latin America increased by 50% due to the adoption of economic and market policies by the Latin American countries, which promote the international flow of goods and the deregulation of markets [
In this way, the consumer is exposed to an offer of products that compete with traditional foods prepared in a homemade style, leading to a loss of family traditions. Likewise, these trade policies favor large food industries such as transnational companies, with extremely high sales that grant them certain political power and the capacity to influence national policies, affecting the supply of healthy foods and the consumption of food products [
According to the results, these products are an obstacle to adequate nutrition because of their high sugar content. In yogurt, which is usually considered a healthy food due to its probiotic properties [
More than 70% of daily sodium intake in adults comes from processed and packaged foods [
Multiple studies have reported that the excessive sodium content in commercial foods aimed at infants and young children stimulates appetite, leading to a greater consumption and preference for this type of products [
Results of the Elliot study [
However, the categories that exceed their content with a ratio of 1 mg of sodium: 1 kilocalorie, and that refer to this in the list of ingredients, include corn snacks. Due to lack of knowledge of the parents or caregivers, probably guided by the brand and advertising, they provide this type of product to infants and young children, considering that they are safe for their health. The younger that these products are facilitated, the greater the problems that may arise, not only related to hypertension, but also to proper kidney functioning, reinforcing the need for cohesive measures to reduce levels of both sodium and sugar in food products aimed at infants and young children that intend to manipulate their palate, stimulate appetite and generate addiction to these foods [
The premature introduction of sugars, influences self-regulation of intake and increases the risk of developing chronic diseases such as type 2 diabetes and dental caries, directly affecting the national healthcare budgets [
Studies carried out by Elliot (2010, 2015) [
Sugary drinks are not recommended nor necessary during the complementary feeding period; they are the main source of added calories and sugar in the diet [
The two mentioned studies also show the relationship between the price and nutritional quality with the most sugary products having the lowest cost, which contributes to the obesogenic effect [
Sodium and sugar share several functions as food ingredients and are used as flavor enhancers. Sugar can enhance natural flavors, such as meats and vegetables, without these having a sweet taste, therefore, categories such as dinner purees show a high sugar content (28%) despite not having a sweet taste [
With regard to energy density, it increases according to the age of the population to which the product is recommended, and it should be noted that snacks as a whole are the ones with the highest energy density, as well as sodium content, particularly corn snacks, which in addition, induce young children to an addiction to this type of products, resulting in the detriment of their health.
In Honduras, there is a wide range of imported processed foods for infants and young children that, in spite of the false notion of being nutritionally adequate or even beneficial, mostly exceed the recommendations of at least one critical nutrient, which generates short and long-term negative impacts in the health of consumers.
Although the present study took a sample of products in the two main cities of Honduras, it gives an idea of the general panorama on the content of sodium and sugar in commercialized baby foods, the lack of regulation and the wide indiscriminate offer, with insufficient information for parents or caregivers to make the best choice of products, to the detriment of the health of infants and young children.
Approximately half of the products evaluated included sugar in the first five positions of the list of ingredients; this is similar to the results reported in previous studies. With regard to sodium content, less than 10% of products referred to it as an ingredient in the first five positions of the corresponding list, although in both cases, their content is not necessarily mentioned in the list of ingredients, which makes it difficult for caregivers to select this type of product.
A low product cost was identified in products with higher sugar content; these were followed by snacks, which were identified as the products with the highest sodium content, greater number of ingredients, energy density and low cost per serving. Both of the above mentioned products have been established as high-risk foods to children’s health.
It is necessary to develop national policies that require a clear and mandatory nutritional labeling in packaged products; this should include a respective description and warnings about the content of critical nutrients. Likewise, it is important to have a universal nutritional profile for this age group prepared by scientific institutions that does not show conflicts of interest.
Finally, collective educational campaigns are required to guide parents and caregivers in order to teach them to discern which the best foods for their children are during this critical stage and thus make informed purchasing decisions, selecting foods according to their nutritional quality.
The authors thank the Institute for Technology in Health Care (ITHC), which agreed to finance the acquisition of children’s meals to carry out the study.
The authors declare no conflicts of interest regarding the publication of this paper.
Hernández, A.S., Motiño, S.R.M., Di Iorio, A.B. and Mérida, C. (2019) How Do Commercial Children’s Foods Influence Their Growth and Development? A Map of Commercially Available Children’s Foods in Honduras. Food and Nutrition Sciences, 10, 174-187. https://doi.org/10.4236/fns.2019.102013