Bár ez a dokumentum az Egyesült Királyságban forgalmazott csecsemőtápszerekről szól, a benne lévő sok általános információ és javaslat minden további nélkül alkalmazható a Magyarországon forgalmazott tápszerekre is. A dokumentum igen nagy jelentőségű amiatt is, hogy ez az első ilyen mélységű és terjedelmű, kereskedelmi érdekektől független, objektív összefoglaló a csecsemőtápszerekről.
Helen Crawley and Susan Westland
The Caroline Walker Trust 2011
Executive summary and recommendations
This report provides information about infant milks available in the UK. The stimulus to produce this report was the lack of any clear, objective and comprehensive information for health professionals about the composition of infant milks and how they are monitored and regulated. The main aim of producing the report is to encourage the relevant health departments of the UK to take greater responsibility in advising health professionals about infant milks, to ensure parents and carers have consistent information when making choices about infant feeding. The world infant formula market is rapidly expanding with a 9% per annum increase globally, reflecting changing infant feeding patterns across the world, and in particular in Asia. It is important that manufacturers in this global market are held to account about the composition of their products which are the sole source of nutrition for many millions of infants around the world.
Babies should wherever possible be exclusively breastfed for the first 6 months of life, and throughout the first year of life, or longer if the mother wishes, alongside complementary food from the age of 6 months. A safe alternative to breast milk, however, remains an essential product as some infants may not be able to receive breast milk for a variety of reasons. Those who use infant milks should be reassured that, whilst we believe that there needs to be greater transparency in the reporting of the composition and safety of infant milks, we are not suggesting that parents and carers should use anything other than a suitable formula milk as an alternative to breast milk in the first year of life.
There are a relatively small number of manufacturers that produce infant milks for the UK market. We have provided information on the types of milks that are available and made comments on their composition. It can be argued that there is little need for some products – for example, follow-on formula, hungry baby milks, partially hydrolysed milks, milks to help with digestion, and goodnight milks – as there is little evidence to support their usefulness. They appear to fulfil a perceived need, rather than an actual need. It can also be argued that some milks that are freely available on the market should not be – for example, infant soya milks and milks based on goats’ milk. In addition there needs to be further debate on the usefulness of growing-up milks and toddler milks. Nutritional requirements for infants aged 12 months and older should be met from a varied, mixed diet rather than from expensive fortified products.
There is insufficient independent information about the nutritional composition of infant milks for sale in the UK. Manufacturers of infant milks were asked, as part of this project, to provide us with information on how they monitor the composition of their milks. Those who did reply said that they have rigorous and regular monitoring procedures in place, but we were not provided with any detailed information about how this is undertaken or how frequently, nor were we provided with any recent results from any manufacturer who sells their products in the UK. Limited data from analytical studies suggest there may be differences between the declared and actual composition of some components of some infant milks. It is also unclear how companies ensure that nutrients are present in the right amounts at point of manufacture and at the end of shelf-life.
Manufacturers are not currently asked to provide annual monitoring information to the Food Standards Agency or to the relevant health departments in the UK. Furthermore, limited data from European surveillance surveys suggest that, in some countries which produce infant milks subsequently sold in the UK, there may be some limitations in the monitoring operations.
The rationale for companies’ reformulating infant milk or making compositional changes is not clear. It would seem reasonable that manufacturers seek agreement with the regulatory authorities before new products are made available. The safety, efficacy and suitability of new ingredients used may be within the current regulations, but there are questions over the safety of allowing their use before an independent committee has checked appropriate evidence. Member states of the European Commission (EC) have requested that all new ingredients are pre-authorised by the European Food Safety Authority (EFSA), and the EC should re-consider this issue.
In this report we have made a number of observations and recommendations that aim to ensure greater transparency about the composition of infant milk. This report has limitations, however. In a dynamic market of considerable size, keeping up to date remains a challenge. It is therefore vital that an expert group takes responsibility for updating infant milk data and for making it readily available to all.
To Government, professional and regulatory bodies
- Relevant Government departments and professional bodies responsible for infant feeding should take responsibility for funding the preparation and distribution of a regularly updated, independent source of information on infant milks available in the UK, including information on their nutritional composition.
- There should be annual independent monitoring of the nutritional composition of all infant formula available on the UK market. These data should be made freely available.
- Health claims on infant milks undermine breastfeeding and an independent and objective body in the UK should review all evidence relating to claims made for infant milks, to support the European Food Safety Authority (EFSA) in objective review of any health claims submitted.
- New infant milks should not be made available on the UK market until their nutritional composition has been independently checked and agreed with the relevant competent authority.
- The UK-wide Infant Feeding Survey, conducted every five years, should collect detailed information from parents on the types and brands of infant formula used from birth and in the first weeks of life.
- Research should be commissioned to consider how parents use ready-to-feed infant milks with regard to quantities used at different ages and whether using prepared milk encourages greater energy consumption by infants.
- Qualitative research should be commissioned which explores parental knowledge and attitudes to infant feeding and infant formula currently available, as well as exploring anxieties about normal infant feeding patterns and behaviour.
- The UK health departments should adopt in full the World Health Assembly recommendation that there should be no advertising of infant formula or follow-on formula to health professionals, parents or carers.
- Manufacturers should be required to have fully transparent monitoring procedures and provide regular updates to the Food Standards Agency or relevant UK health departments regarding how and when infant milk composition and safety are checked.
This should include both nutritive and non-nutritive components.
- Manufacturers should be required to provide evidence of the efficacy of their products using studies that are fully relevant to the group for which the product is indicated and that reflect the composition of their product. Evidence should be agreed and checked by an independent body before it is made available to health professionals and others.
- A pooled fund from all manufacturers of infant milks in the EC, based on a percentage of profits made from the sale of infant milks, should be made available to facilitate objective research on infant milks.
- Manufacturers should ensure that the information available on their websites reflects the composition and nature of the products currently available on the market and that all information provided is in line with current recommendations from the relevant health departments of the UK.
- All infant milk producers should adapt their feeding guidelines so they are consistent with the feeding guidelines for infant age and weight agreed by health professional bodies in the UK.
- All infant milk powders should be clearly labelled that they are non-sterile and may contain pathogenic micro-organisms, as recommended by the World Health Assembly (2005).
- All information given to parents and carers on product packaging, in supporting literature, on websites and from careline staff about how to make up infant milks safely should be in line with current Government guidance.
To health professionals
- Health professionals and others who support parents and carers to make choices about infant feeding should request, and use, objective, independent and up-to-date information about infant milk from their professional body or from their relevant health department.
- All those involved in supporting parents and carers to make choices about how to feed infants should receive mandatory training which clearly explains the differences between breast milk and formula milk, the types of formula available, any implications of their compositional differences, and their indications for use.
- Clear and consistent information should be provided to all parents and carers about how to make up infant milks safely.