Press release 23 December 2009
Health advocates predict a decline in breastfeeding if a new opinion of the European Food Safety Authority (EFSA) which is at variance with that of the World Health Organisation is translated into european legislation. The opinion which was issued on the 21st December (1) is a backward step and plays into the hands of the baby food industry which is trying to undermine moves to improve the 1996 EU baby food Directive. (2) It flies in the face of the global recommendation of the World Health Assembly, which was arrived at after a systematic review of over 3000 studies and is now policy in over 70 countries, including the UK. (3)
Labelling of baby foods as suitable from 4-months encourages the introduction of solid foods before the vast majority of babies are developmentally ready to eat family foods. Too early introduction of solids along with the high levels of sugar permitted in EU legislation contributes to the rising levels of childhood obesity. (4)
Patti Rundall, OBE, Policy Director of Baby Milk Action, says: “This is a regrettable and backward step that is out of step with current scientific thinking, and could really undermine government’s efforts to protect and support optimum infant feeding practices. Its vital EU Member states examine the public health policy implications of this issue, and not blindly follow this recommendation which in my view will benefit only the baby food industry.”
Some concerns about the EFSA Opinon:
- The EFSA opinion is illogical and contradictory. It acknowledges that “full breast feeding for up to 6 months provides greater protection than partial breast feeding or shorter breast feeding against the risk of infectious morbidity.” But in its conclusion states that “the introduction of complementary food….between the age of 4 and 6 months is safe and does not pose a risk for adverse health effects….” If foods are started 4-6 months, breastfeeding cannot be full or exclusive for 6 months so babies are put at unnecessary risk of increased morbidity. A nationally representative study in the USA in 2006 documented that children who received only breastmilk for the first 6 months as recommended had fewer chest and ear infections than those breastfed for shorter periods, supporting the current recommendations in the USA that infants receive only breast milk for the first 6 months of life.(5)
- Impact on public health recommendations: EFSA has failed to consider the issue of developmental readiness, or the wider issue of how public health recommendations are interpreted. Before the UK adopted the WHO 6 month recommendation, the 5-yearly UK Infant Feeding Surveys shows that most babies were given solids far too early, before 4 months.(6) The message to start solids from 6 months led to a postponement until the 4-5 months, an important behavioural shift in public health terms. The proportion of mothers introducing solid foods by 4 months fell from 85% in 2000 to 51% in 2005. The proportion introducing by 3 months halved in that five years, from about 23% to 10%.(6) If the EFSA opinion is used to inform policy one can expect a reversal of this positive trend.
- Over-emphasis on Coeliac Disease. The studies used by EFSA regarding the age of introduction of gluten use at risk populations, but give no convincing argument for introducing solids to breastfed babies between 4-6 months rather than after six months. A much more important factor in reducing the incidence of Coeliac Disease seems to be the continuation of breastfeeding alongside the introduction of gluten.
Baby Milk Action has campaigned for many years to increase the transparency of EU scientific bodies and reduce the undue corporate influence on EU policy making, and since 2000, European Commission advisory bodies such as EFSA have to make annual declarations of financial links to industry.(7) However, as this opinion seems to indicate, industry’s influence still remains. One member of the EFSA Working Group tasked with examining this issue, Carlo Agostini, declares funding from 9 baby food companies (8) and was also a co-author of a paper on Complementary Feeding by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) which reintroduces the concept of complementary feeding from 4-6 months.(9) ESPGHAN itself is sponsored by the Nestlé Nutrition Institute and by Dr Schar, the leading European manufacturer of gluten free foods for sufferers of Coeliac Disease – a condition that is emphasised in the opinion.
Nestlé, the world’s biggest producer of infant formula, continues to undermine World Health Assembly Resolutions which since 1994 have called for the protection of exclusive breastfeeding from about 6 months. Since 2001, following campaigning by IBFAN and supporters of the Nestlé boycott, Nestlé has claimed to support the 6-month recommendation and in 2003 undertook to change the labels on its complementary foods. However its observance of this promise has been patchy and applies only to certain developing countries and elsewhere Nestle aggressively markets foods from 4 months of age.
For more information contact Patti Rundall 07786 523493
- Scientific Opinion on the appropriate age for introduction of complementary feeding of infants 1 EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) 2, 3 European Food Safety Authority (EFSA), Parma, Italy
Overall conclusion: In response to a request of the Commission to give an Opinion on the appropriate time for the introduction of complementary food into infants? diet in the EU, the Panel concludes the following: On the basis of present knowledge the Panel concludes that the introduction of complementary food into the diet of healthy term infants in the EU between the age of 4 and 6 months is safe and does not pose a risk for adverse health effects (both in the short-term, including infections and retarded and excessive weight gain, and possible long-term effects such as allergy and obesity). Consistent with these conclusions, presently available data on the risk of celiac disease and T1DM support also the timing of the introduction of gluten containing food (preferably while still breast-feeding) not later than 6 months of age. Exclusive breast-feeding is nutritionally adequate up to 6 months for the majority of infants, while some infants may need complementary foods before 6 months (but not before the age of 4 months) in addition to breast-feeding to support optimal growth and development.
- COMMISSION DIRECTIVE 96/5/EC of 16 February 1996 on processed cereal-based foods and baby foods for infants (Codified version Commission Directive 2006/125/EC (OJ L339, p16, 06/12/2006 ) of 5 December 2006)
- Resolution (WHA 54.2 ) 2001 URGES Member States:
2.6: to improve complementary foods and feeding practices by ensuring sound and culture-specific nutrition counselling to mothers of young children, recommending the widest possible use of indigenous nutrient-rich foodstuffs;
3 REQUESTS the Director-General: 3.3) to provide support to Member States in the identification, implementation and evaluation of innovative approaches to improving infant and young child feeding, emphasizing exclusive breastfeeding for six months as a global public health recommendation, taking into account the findings of the WHO expert consultation on optimal duration of exclusive breastfeeding (note 1), the provision of safe and appropriate complementary foods, with continued breastfeeding up to two years of age or beyond, and community-based and cross-sector activities;
- EU and US block Thailand’s proposal to reduce sugar in baby foods 3 Nov 2006
- Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US Children PEDIATRICS Vol. 117 No.2 February 2006, pp. 425-432
- Infant Feeding Survey 2005, Keith Bolling, Catherine Grant, Becky Hamlyn, Alex Thornton, ONS
Infant Feeding Survey 2005: A commentary on infant feeding practices in the UK Position statement by the Scientific Advisory Committee on Nutrition 2008 paras 40 and 90-100.
- EU advisory committee members declare their interests BMJ 2000;320:826 ( 25 March 2000)
- Carlo Agostini Annual Declaration of Interest (06/07/2009) lists fees for Scientific publications, speaker’s fees and conference expenses from Danone, Heinz, Hipp, Humana, Martek, Mead Johnson, Mellin, Milupa and Nestlè.
- Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 46:99–110 # 2008 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition