Commercial milk formula marketing following increased restrictions in Singapore: A qualitative study

The promotion of commercial milk formula (CMF) negatively impacts breastfeeding outcomes. In 2019, Singapore updated its 1979 Code of Ethics of the Sale of Infant Foods Ethics Committee Singapore (SIFECS) to increase marketing restrictions on CMF for infants 0-12 months. However, little is known about industry tactics to undermine these restrictions. This qualitative study explores health workers' and mothers' experiences with CMF marketing in Singapore following the 2019 restrictions. We conducted a qualitative study, using semistructured interviews with 14 mothers of infants aged less than 5 months and 20 health workers with expertise in antenatal, maternity, or paediatric care. We analysed data thematically using inductive coding. Five themes were identified. Mothers and health workers reported digital marketing, product line extensions with toddlers' milk and milk for mothers, and CMF sponsorships in the healthcare setting. Expert endorsement, competitive price, nutritional claims, and brand reputation influenced mothers' infant formula choices, yet both mothers and health workers appeared to be unaware of the impact of CMF marketing tactics on their own perceptions. The restriction of CMF marketing and infant feeding practices varied widely between hospitals, with private hospitals and practices having less strict controls on CMF marketing. Despite the updated SIFECS restrictions, CMF companies continue to target mothers and health workers in Singapore. SIFECS restrictions should be tightened to align with international guidelines, by increasing their scope to include toddlers' milk and prohibiting cross-promotion, digital marketing, and any sponsorships of events targeting health workers that may create a conflict of interest.

Soy Milk Consumption in the United States of America: An NHANES Data Report

With the increasing adoption of plant-based diets in the United States, more and more individuals replace cow milk with plant-based milk alternatives. Soy milk is a commonly used cow milk substitute, which is characterized by a higher content of polyunsaturated fatty acids and fibers. Despite these favorable characteristics, little is known about the current prevalence of soy milk consumption the United States. We used data from the National Health and Nutrition Examination Surveys (NHANES) to assess soy milk usage in the United States and identified potential predictors for its consumption in the US general population. The proportion of individuals reporting soy milk consumption in the NHANES 2015-2016 cycle was 2%, and 1.54% in the NHANES 2017-2020 cycle. Non-Hispanic Asian and Black ethnicities (as well as other Hispanic and Mexican American ethnicities in the 2017-2020 cycle) significantly increased the odds for soy milk consumption. While a college degree and weekly moderate physical activity were associated with significantly higher odds for consuming soy milk (OR: 2.21 and 2.36, respectively), sex was not an important predictor. In light of the putative health benefits of soy milk and its more favorable environmental impact as compared to cow milk, future investigations should attempt to identify strategies that may help promote its consumption in selected populations.

Cost-effectiveness of infant hypoallergenic formulas to manage cow's milk protein allergy in France

BACKGROUND

Clinician's choice of hypoallergenic formulas in the first-line management of cow's milk protein allergy (CMPA) should be informed by evidence on clinical efficacy and cost-effectiveness.

OBJECTIVE

We compare the cost-effectiveness of amino acid-based formula (AAF), extensively hydrolyzed casein formula with Lactobacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), and rice hydrolyzed formula (RHF) in non-breastfed children in France.

METHODS

Immunotolerance and atopic manifestations' prevalence were based on a prospective non-randomized study with a 36-month follow-up. Resource utilization was sourced from a survey of French clinicians, and unit costs were based on national data. Costs and health consequences were discounted at 2.5% annually. Results were reported using the Collective and French National Health Insurance perspectives.

RESULTS

Children receiving EHCF+LGG were predicted to require less healthcare resources, given their reduced prevalence of CMPA symptoms at 3 years. In the base case, EHCF+LGG led to savings of at least €674 per child compared to AAF, EHWF, and RHF at 3 years, from both perspectives. Nutrition had the highest economic burden in CMPA, driven by hypoallergenic formulas and dietetic replacements costs. Results were robust to one-way and probabilistic sensitivity analyses.

CONCLUSIONS

EHCF+LGG was associated with more symptom-free time, higher immune tolerance, and lower costs.

Properties of Rice-Based Beverages Fermented with Lactic Acid Bacteria and Propionibacterium

In recent times, consumers have shown increasing interest in plant substitutes for fermented dairy products. This study aimed to investigate the properties of yogurt-type rice-based beverages fermented with lactic acid bacteria and Propionibacterium. The changes in pH, viable population of bacteria, physical properties, and carbohydrate content of these beverages were tested. Fermentation using only Propionibacterium was insufficient to obtain a product with an acidity level similar to that of milk-based yogurt (pH < 4.5). After fermentation, the tested beverages had a high number of Lactobacillus sp. (7.42−8.23 log10 CFU/mL), Streptococcus thermophilus (8.01−8.65 log10 CFU/mL), and Bifidobacterium animalis subsp. lactis (8.28−8.50 log10 CFU/mL). The hardness (2.90−10.40 N) and adhesiveness (13.79−42.16 mJ) of the samples after 14 days of storage at 6 °C varied depending on the starter culture used. The syneresis of all samples ranged between 29% and 31%, which was lower or close to that of milk-based yogurts. The content of individual sugars in the samples also varied depending on the starter culture used for fermentation. The results suggest that the combination of lactic and propionic fermentation helps in the production of rice-based yogurt-type milk substitutes.

In Vitro Protein Digestibility and Fatty Acid Profile of Commercial Plant-Based Milk Alternatives

Plant-based milk alternatives (PBMA) are a new popular food trend among consumers in Europe and North America. The forecast shows that PBMA will double their value by 2023. The objective of this study was to analyze the nutritional value of commercial products in terms of their fatty acid profile and protein digestibility from commercial PBMA. Eight commercially available PBMA were selected for fatty acid analysis, performed with gas chromatography of methylated fatty acids (GC-FAME), and, from these, four commercial products (almond drink, hemp drink, oat drink, and soy drink) were selected for a short-term in vitro protein digestibility (IVPD) analysis. The fatty acid analysis results showed that most of the products predominantly contained oleic acid (C18:1 ω-9) and linoleic acid (C18:2 ω-6). Hemp drink contained the highest omega-6/omega-3 (ω6/ω3) ratio among all tested products (3.43). Oat drink and almond drink were the PBMA with the highest short-term protein digestibility, non-significantly different from cow’s milk, while soy drink showed the lowest value of protein digestibility. In conclusion, PBMA showed a significant variability depending on the plant source, both in terms of fatty acid composition and protein digestibility. These results provide more in-depth nutritional information, for future product development, and for consumer’s choice.

Erosive potential of soy-based beverages on dental enamel

BACKGROUND

This study aimed to investigate the erosive potential of soy-based beverages in comparison to fruit juices of the same flavor.

METHODS

Human enamel blocks were randomly divided into 9 groups (n = 8), according to the beverage category (soy or non-soy juices). The initial pH, TA and β at the original pH value were measured in triplicate. The composition of calcium, phosphate and total protein was analyzed using the specific colorimetric method. The fluoride analysis was performed using a selective electrode. The degree of saturation (DS) and the critical pH (CpH) of each beverage with respect to hydroxyapatite (HAp) and fluorapatite (FAp) were calculated using the computational software. Enamel samples were immersed into 67.5 mL of each drink for 120 minutes. Enamel surface loss (ESL) and differences in surface roughness (ΔRa_E-S) were analyzed by a 3D non-contact profilometer.

RESULTS

Non-soy beverages exhibited the lowest pH values (2.93 to 3.40). The highest values of calcium concentration were founded in soy-based formulations. Juices with soy in their composition tend to have high DS when compared with non-soy based beverages (p = .0571). Soy beverages produced less ESL than non-soy beverages (p < .05). ΔRa_E-S was not significantly different between the categories. The ESL and ΔRa_E-S were positively correlated with initial pH and buffering capacity in soy-based beverages. On the other hand, in non-soy beverages, the ESL was negatively correlated with the TA to 7.0 and the fluoride composition whereas the ΔRa_E-S was negatively correlated with the TA to 5.5.

CONCLUSIONS

The erosive potential of soy beverages was lower than non-soy based beverages.

Types of Milk and/or Its Substitutes Are Given to Children (6⁻36 Months) in Nurseries in Poland: Data from the Research and Education Project "Eating Healthy, Growing Healthy"

The purpose of the study was to evaluate the types of milk and/or its substitutes given to children (aged 6⁻36 months) in nurseries in Poland. Methods: The study was conducted in 211 nurseries across Poland. The supply of milk and its substitutes was checked in ten-day menus and inventory documents. In total, 211 ten-day menus and 2110 daily inventory reports were analyzed. Additionally, data were obtained by interviews with day-care center (DCC) directors and/or staff responsible for nutrition. Results: Compared to non-public nurseries, public ones were characterized by a higher average number of children, most often maintained their own kitchens, and charged a lower financial fee. Public DCCs also more often employed dietitians. The type of milk and its substitutes offered to children in nurseries was dependent on the age of the children and type of DCC. In a larger percentage of public DCCs infants received a milk formula, and in smaller percentage they received breast milk. This regularity also occurred in older children's diets (13⁻36 months). In toddlers' diets in public nurseries, cow's milk was more common. The share of other milk substitutes in the nutrition of children from both age groups was negligible. Conclusion: The types of milk given to children in nurseries in Poland varied and depended on the age of children and the type of DCCs. It is necessary to provide education to DCC staff regarding the type of milk recommended for children under one year of age.

Dairy goat kids fed liquid diets in substitution of goat milk and slaughtered at different ages: an economic viability analysis using Monte Carlo techniques

The aim of this study was to analyze the economic viability of producing dairy goat kids fed liquid diets in alternative of goat milk and slaughtered at two different ages. Forty-eight male newborn Saanen and Alpine kids were selected and allocated to four groups using a completely randomized factorial design: goat milk (GM), cow milk (CM), commercial milk replacer (CMR) and fermented cow colostrum (FC). Each group was then divided into two groups: slaughter at 60 and 90 days of age. The animals received Tifton hay and concentrate ad libitum. The values of total costs of liquid and solid feed plus labor, income and average gross margin were calculated. The data were then analyzed using the Monte Carlo techniques with the @Risk 5.5 software, with 1000 iterations of the variables being studied through the model. The kids fed GM and CMR generated negative profitability values when slaughtered at 60 days (US$ -16.4 and US$ -2.17, respectively) and also at 90 days (US$ -30.8 and US$ -0.18, respectively). The risk analysis showed that there is a 98% probability that profitability would be negative when GM is used. In this regard, CM and FC presented low risk when the kids were slaughtered at 60 days (8.5% and 21.2%, respectively) and an even lower risk when animals were slaughtered at 90 days (5.2% and 3.8%, respectively). The kids fed CM and slaughtered at 90 days presented the highest average gross income (US$ 67.88) and also average gross margin (US$ 18.43/animal). For the 60-day rearing regime to be economically viable, the CMR cost should not exceed 11.47% of the animal-selling price. This implies that the replacer cannot cost more than US$ 0.39 and 0.43/kg for the 60- and 90-day feeding regimes, respectively. The sensitivity analysis showed that the variables with the greatest impact on the final model's results were animal selling price, liquid diet cost, final weight at slaughter and labor. In conclusion, the production of male dairy goat kids can be economically viable when the kids diet consists mainly of either cow milk or fermented colostrum, especially when kids are slaughtered at 90 days of age.