Commercial complementary food use amongst European infants and children: results from the EU Childhood Obesity Project



The objective of this secondary analysis is to describe the types of commercial complementary foods (CCF) consumed by infants and young children enrolled in the European Childhood Obesity Project (CHOP), to describe the contribution of CCF to dietary energy intakes and to determine factors associated with CCF use over the first 2 years of life.


The CHOP trial is a multicenter intervention trial in Germany, Belgium, Italy, Poland and Spain that tested the effect of varying levels of protein in infant formula on the risk for childhood obesity. Infants were recruited from October 2002 to June 2004. Dietary data on CCF use for this secondary analysis were taken from weighted, 3-day dietary records from 1088 infants at 9 time points over the first 2 years of life.


Reported energy intakes from CCF during infancy (4–9 months) was significantly higher (p ≤ 0.002) amongst formula-fed children compared to breastfed children. Sweetened CCF intakes were significantly higher (p ≤ 0.009) amongst formula-fed infants. Female infants were fed significantly less CCF and infant age was strongly associated with daily CCF intakes, peaking at 9 months of age. Infants from families with middle- and high-level of education were fed significantly less quantities of CCF compared to infants with parents with lower education. Sweetened CCF were very common in Spain, Italy and Poland, with over 95% of infants and children fed CCF at 9 and 12 months of age consuming at least one sweetened CCF. At 24 months of age, 68% of the CHOP cohort were still fed CCF.


CCF comprised a substantial part of the diets of this cohort of European infants and young children. The proportion of infants being fed sweetened CCF is concerning. More studies on the quality of commercial complementary foods in Europe are warranted, including market surveys on the saturation of the Western European market with sweetened CCF products.

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We thank the participating families and all project partners for their enthusiastic support of the project. The European Childhood Obesity Trial Study Group: Philippe Goyens, Clotilde Carlier, Joana Hoyos, Pascale Poncelet, Elena Dain (Université Libre de Bruxelles –Brusselles, Belgium); Françoise Martin, Annick Xhonneux, Jean-Paul Langhendries, Jean-Noel Van Hees (CHC St Vincent –Liège-Rocourt, Belgium); Ricardo Closa-Monasterolo, Joaquin Escribano, Veronica Luque, Georgina Mendez, Natalia Ferre, Marta Zaragoza-Jordana, Mariona Gispert-Llauradó, Carme Rubio-Torrents (Universitat Rovira i Virgili, IISPV, Taragona, Spain); Marcello Giovannini, Enrica Riva, Carlo Agostoni, Silvia Scaglioni, Elvira Verduci, Fiammetta Vecchi, Alice Re Dionigi (University of Milano, Milano, Italy); Jerzy Socha, Piotr Socha (Children’s Memorial Health Institute, Department of Gastroenterology, Hepatology and Immunology, Warsaw, Poland); Anna Dobrzańska, Dariusz Gruszfeld (Children’s Memorial Health Institute, Neonatal Intensive Care Unit, Warsaw, Poland); Anna Stolarczyk (Children’s Memorial Health Institute, Department of Gastroenterology, Warsaw, Poland); Roman Janas (Children’s Memorial Health Institute, Diagnostic Laboratory, Warsaw, Poland); Emmanuel Perrin (Danone Research Centre for Specialized Nutrition, Schiphol, The Netherlands); Rüdiger von Kries (Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig Maximilians University of Munich, Munich, Germany); Helfried Groebe, Anna Reith, Renate Hofmann (Klinikum Nurnberg Sued, Nurnberg, Germany); Berthold Koletzko, Veit Grote, Martina Totzauer, Peter Rzehak, Sonia Schiess, Jeannette Beyer, Michaela Fritsch, Uschi Handel, Ingrid Pawellek, Sabine Verwied-Jorky, Iris Hannibal, Hans Demmelmair, Gudrun Haile, Melissa Theurich (Division of Nutritional Medicine and Metabolism, Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany).


The authors’ work is financially supported in part by the Commission of the European Communities, Projects Early Nutrition (FP7-289346), DYNAHEALTH (H2020-633595) and LIFECYCLE (H2020-SC1-2016-RTD), and the European Research Council Advanced Grant META-GROWTH (ERC-2012-AdG 322605). This manuscript does not necessarily reflect the views of the Commission and in no way anticipates the future policy in this area.

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Theurich, M.A., Zaragoza-Jordana, M., Luque, V. et al. Commercial complementary food use amongst European infants and children: results from the EU Childhood Obesity Project. Eur J Nutr 59, 1679–1692 (2020).

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  • Complementary feeding
  • Commercial complementary foods
  • Sugar
  • Europe
  • Baby foods