Rafael Urrialde de Andrés
Full member and Vice-President of the Royal European Academy of Doctors (RAED), and Honorary Member of the Spanish Academy of Nutrition and Dietetics (AEND)
It is an interesting study, but it is very surprising – as is often the case with many scientific studies – that the title does not specify the location where the fieldwork was carried out and the study sample was selected: the United Kingdom.
The study’s title should, without fail, include the country in which the research was carried out, particularly in this piece of work, which calls for legislative regulation of the products analysed. This is a major shortcoming which the reviewers, during the peer-review and approval process, should have highlighted as a major comment.
In the case of the European Union, there is legislation on this matter (Regulation (EU) No 609/2013 of the European Parliament and of the Council concerning specific compositional and labelling requirements for infant formulae and follow-on formulae, as well as labelling requirements for foods intended for infants and young children); moreover, in Spain we have Royal Decree 490/1998 of 27 March, which approves the specific technical and health regulations for cereal-based foods and infant foods for infants and young children; this covers aspects not included in the EU Regulation, where Article 4(2)(1) states: “The age from which the product may be consumed, taking into account its composition, texture and other specific properties. The age indicated shall be at least four months for any product. For products recommended from four months of age, it may be stated that they are suitable from that age, unless otherwise indicated by an independent and competent person in medicine, nutrition or pharmacy, or another professional providing care for mothers and children”.
Therefore, depending on their fruit and cereal composition, they are recommended for ages +4 months, +6 months, +8 months and +12 months. Another aspect, to prevent choking hazards—just as when preparing food at home—is the texture; generally speaking, it should be as fine as possible for foods consumed before 12 months of age. They contain no added sugars; this information should be mandatory on labelling in the EU but is not yet required for all food products.
The sugar content comes from the fruit, cereals or dairy products that make up these foods; as they are puréed, these are no longer intrinsic sugars but are free sugars. However, just as when food is made or prepared at home, the balance between puréed and whole forms must be considered; for the target consumer, the food must be puréed. Nor is it reasonable, within the context of sugar content limits, to compare those found in fruit or cereals with those present in milk; lactose has nothing in common with fructose, glucose and/or sucrose, either in terms of digestibility or composition, This is the case, but as with any food product introduced at that age, the introduction of these foods from 4 months onwards – known as complementary feeding or ‘beikost’ – must be done gradually in order to detect any possible allergies or intolerances in the infant, and this process must be supervised by a paediatrician.
In conclusion, this is a study that, in terms of content and legislation, applies exclusively to the United Kingdom; and when weighing up the risks and benefits, one must consider the process of introducing complementary feeding from four months onwards, with texture being critical. The food must be intended as a complement to, and not a substitute for, breast milk or infant formula, as well as the infant’s other foods, particularly if it is introduced between four and six months of age.