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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ghisolfi J, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Girardet JP, Goulet O, Hankard R, Rieu D, Simeoni U, Turck D, Vidailhet M (2013) Processed baby foods for infants and young children: a dietary advance? A position paper by the Committee on Nutrition of the French Society of Paediatrics. Arch Pediatr 20(5):523–532. https://doi.org/10.1016/j.arcped.2013.02.072
Maslin K, Venter C (2017) Nutritional aspects of commercially prepared infant foods in developed countries: a narrative review. Nutr Res Rev 30(1):138–148. https://doi.org/10.1017/s0954422417000038
Maalouf J, Cogswell ME, Bates M, Yuan K, Scanlon KS, Pehrsson P, Gunn JP, Merritt RK (2017) Sodium, sugar, and fat content of complementary infant and toddler foods sold in the United States, 2015. Am J Clin Nutr 105(6):1443–1452. https://doi.org/10.3945/ajcn.116.142653
Cogswell ME, Gunn JP, Yuan K, Park S, Merritt R (2015) Sodium and sugar in complementary infant and toddler foods sold in the United States. Pediatrics 135(3):416–423. https://doi.org/10.1542/peds.2014-3251
Moding KJ, Ferrante MJ, Bellows LL, Bakke AJ, Hayes JE, Johnson SL (2018) Variety and content of commercial infant and toddler vegetable products manufactured and sold in the United States. Am J Clin Nutr 107(4):576–583. https://doi.org/10.1093/ajcn/nqx079
Reidy KC, Bailey RL, Deming DM, O’Neill L, Carr BT, Lesniauskas R, Johnson W (2018) Food consumption patterns and micronutrient density of complementary foods consumed by infants fed commercially prepared baby foods. Nutr Today 53(2):68–78. https://doi.org/10.1097/NT.0000000000000265
Hurley KM, Black MM (2010) Commercial baby food consumption and dietary variety in a statewide sample of infants receiving benefits from the special supplemental nutrition program for women, infants, and children. J Am Diet Assoc 110(10):1537–1541. https://doi.org/10.1016/j.jada.2010.07.002
Carstairs SA, Craig LC, Marais D, Bora OE, Kiezebrink K (2016) A comparison of preprepared commercial infant feeding meals with home-cooked recipes. Arch Dis Child 101(11):1037–1042. https://doi.org/10.1136/archdischild-2015-310098
Crawley H, Westland S (2017) Baby foods in the UK. First Steps Nutrition Trust, London
Koletzko B, Lehmann Hirsch N, Jewell JM, Caroli M, Da Silva Rodrigues, Breda J, Weber M (2018) Pureed fruit pouches for babies: child health under squeeze. J Pediatr Gastroenterol Nutr 67(5):561–563. https://doi.org/10.1097/mpg.0000000000002061
Koletzko B, Buhrer C, Ensenauer R, Jochum F, Kalhoff H, Lawrenz B, Korner A, Mihatsch W, Rudloff S, Zimmer KP (2019) Complementary foods in baby food pouches: position statement from the Nutrition Commission of the German Society for Pediatrics and Adolescent Medicine (DGKJ, e.V.). Mol Cell Pediatr 6(1):2. https://doi.org/10.1186/s40348-019-0089-6
Koletzko B, Demmelmair H, Grote V, Prell C, Weber M (2016) High protein intake in young children and increased weight gain and obesity risk. Am J Clin Nutr 103(2):303–304. https://doi.org/10.3945/ajcn.115.128009
Grote V, Schiess SA, Closa-Monasterolo R, Escribano J, Giovannini M, Scaglioni S, Stolarczyk A, Gruszfeld D, Hoyos J, Poncelet P, Xhonneux A, Langhendries JP, Koletzko B, European Childhood Obesity Trial Study G (2011) The introduction of solid food and growth in the first 2 y of life in formula-fed children: analysis of data from a European cohort study. Am J Clin Nutr 94(6 Suppl):1785S–1793S. https://doi.org/10.3945/ajcn.110.000810
Koletzko B, Broekaert I, Demmelmair H, Franke J, Hannibal I, Oberle D, Schiess S, Baumann BT, Verwied-Jorky S, Project EUCO (2005) Protein intake in the first year of life: a risk factor for later obesity? The E.U. childhood obesity project. Adv Exp Med Biol 569:69–79
Verwied-Jorky S, Schiess S, Luque V, Grote V, Scaglioni S, Vecchi F, Martin F, Stolarczyk A, Koletzko B, European Childhood Obesity P (2011) Methodology for longitudinal assessment of nutrient intake and dietary habits in early childhood in a transnational multicenter study. J Pediatr Gastroenterol Nutr 52(1):96–102. https://doi.org/10.1097/MPG.0b013e3181f28d33
European Commission (2006) Commission Directive 2006/125/EC on processed cereal-based foods and baby foods for infants and young children. Off J Eur Union (399):16–34. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32006L0125&from=EN
The Stata Journal (2015) Stata Press, College Station Texas, USA. https://www.stata-journal.com
Foterek K, Hilbig A, Kersting M, Alexy U (2016) Age and time trends in the diet of young children: results of the DONALD study. Eur J Nutr 55(2):611–620. https://doi.org/10.1007/s00394-015-0881-6
Smithers LG, Brazionis L, Golley RK, Mittinty MN, Northstone K, Emmett P, McNaughton SA, Campbell KJ, Lynch JW (2012) Associations between dietary patterns at 6 and 15 months of age and sociodemographic factors. Eur J Clin Nutr 66:658
Foterek K, Hilbig A, Alexy U (2014) Breast-feeding and weaning practices in the DONALD study: age and time trends. J Pediatr Gastroenterol Nutr 58(3):361–367. https://doi.org/10.1097/MPG.0000000000000202
Schiess S, Grote V, Scaglioni S, Luque V, Martin F, Stolarczyk A, Vecchi F, Koletzko B, European Childhood Obesity P (2010) Introduction of complementary feeding in 5 European countries. J Pediatr Gastroenterol Nutr 50(1):92–98. https://doi.org/10.1097/MPG.0b013e31819f1ddc
World Health Organization (2005) Guiding principles for feeding non-breastfed children 6–24 months of age. Geneva
Butte NF, Wong WW, Hopkinson JM, Heinz CJ, Mehta NR, Smith EO (2000) Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. Am J Clin Nutr 72(6):1558–1569. https://doi.org/10.1093/ajcn/72.6.1558
Li R, Fein SB, Grummer-Strawn LM (2010) Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics 125(6):e1386–e1393. https://doi.org/10.1542/peds.2009-2549
Disantis KI, Collins BN, Fisher JO, Davey A (2011) Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? Int J Behav Nutr Phys Act 8:89. https://doi.org/10.1186/1479-5868-8-89
Garcia AL, Raza S, Parrett A, Wright CM (2013) Nutritional content of infant commercial weaning foods in the UK. Arch Dis Child 98(10):793–797. https://doi.org/10.1136/archdischild-2012-303386
Garcia AL, McLean K, Wright CM (2016) Types of fruits and vegetables used in commercial baby foods and their contribution to sugar content. Matern Child Nutr 12(4):838–847. https://doi.org/10.1111/mcn.12208
Cattaneo A, Monasta L, Stamatakis E, Lioret S, Castetbon K, Frenken F, Manios Y, Moschonis G, Savva S, Zaborskis A, Rito AI, Nanu M, Vignerová J, Caroli M, Ludvigsson J, Koch FS, Serra-Majem L, Szponar L, Van Lenthe F, Brug J (2010) Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev 11(5):389–398. https://doi.org/10.1111/j.1467-789X.2009.00639.x
Franco M, Sanz B, Otero L, Dominguez-Vila A, Caballero B (2010) Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010. Gac Sanit 24(Suppl 1):49–55. https://doi.org/10.1016/j.gaceta.2010.09.014
Foterek K, Hilbig A, Alexy U (2015) Associations between commercial complementary food consumption and fruit and vegetable intake in children. Results of the DONALD study. Appetite 85:84–90. https://doi.org/10.1016/j.appet.2014.11.015
Foterek K, Buyken AE, Bolzenius K, Hilbig A, Nothlings U, Alexy U (2016) Commercial complementary food consumption is prospectively associated with added sugar intake in childhood. Br J Nutr 115(11):2067–2074. https://doi.org/10.1017/S0007114516001367
World Health Organization (2017) Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children: Implementation Manual. World Health Organization, Geneva. doi:Licence: CC BY-NC-SA 3.0 IGO. https://apps.who.int/iris/handle/10665/260137
Theurich MA (2018) World Health Assembly Resolution 69.9 calls for an end to unethical marketing of “baby foods”. J Hum Lactation 34(2):272–275. https://doi.org/10.1177/0890334418754783
Hozyasz KK, Radomyska B, Kot K (2010) The Mediterranean diet for Polish infants: a losing struggle or a battle still worth fighting? Med J Nutrition Metab 3(3):227–232. https://doi.org/10.1007/s12349-010-0025-8
Beauchamp GK, Mennella JA (2009) Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr 48(Suppl 1):S25–S30. https://doi.org/10.1097/MPG.0b013e31819774a5
Mesch CM, Stimming M, Foterek K, Hilbig A, Alexy U, Kersting M, Libuda L (2014) Food variety in commercial and homemade complementary meals for infants in Germany. Market survey and dietary practice. Appetite 76:113–119. https://doi.org/10.1016/j.appet.2014.01.074
Mennella JA, Ventura AK (2011) Early feeding: setting the stage for healthy eating habits. Nestle Nutr Workshop Ser Pediatr Program 68:153–163. https://doi.org/10.1159/000325783(discussion 164–158)
Mennella JA (2014) Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr 99(3):704s–711s. https://doi.org/10.3945/ajcn.113.067694
Maier-Nöth A, Schaal B, Leathwood P, Issanchou S (2016) The lasting influences of early food-related variety experience: a longitudinal study of vegetable acceptance from 5 months to 6 years in two populations. PLoS One 11(3):e0151356–e0151356. https://doi.org/10.1371/journal.pone.0151356
Chabanet C, Remy E, Issanchou S, Nicklaus S (2013) Repeated exposure of infants at complementary feeding to a vegetable purée increases acceptance as effectively as flavor–flavor learning and more effectively than flavor-nutrient learning. J Nutr 143(7):1194–1200. https://doi.org/10.3945/jn.113.175646
Nicklaus S (2016) Complementary feeding strategies to facilitate acceptance of fruits and vegetables: a narrative review of the literature. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph13111160
Fewtrell M, Bronsky J, Campoy C, Domellof M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C (2017) Complementary feeding: a position paper by the european society for paediatric gastroenterology, hepatology, and nutrition (espghan) committee on nutrition. J Pediatr Gastroenterol Nutr 64(1):119–132. https://doi.org/10.1097/MPG.0000000000001454
Dewey K (2003) Guiding principles for complementary feeding of the breastfed child. Pan American Health Organization, Washington DC
Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Michaelsen KF, Moreno L, Puntis J, Rigo J, Shamir R, Szajewska H, Turck D, van Goudoever J (2008) Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 46(1):99–110. https://doi.org/10.1097/01.mpg.0000304464.60788.bd
Kersting M (2001) Ernährung des gesunden Säuglings Lebensmittel- und mahlzeitenbezogene Empfehlungen. Monatsschr Kinderheilkd 149:4–10
Pries AM, Huffman SL, Mengkheang K, Kroeun H, Champeny M, Roberts M, Zehner E (2016) High use of commercial food products among infants and young children and promotions for these products in Cambodia. Matern Child Nutr 12(Suppl 2):52–63. https://doi.org/10.1111/mcn.12270
Pries AM, Huffman SL, Adhikary I, Upreti SR, Dhungel S, Champeny M, Zehner E (2016) High consumption of commercial food products among children less than 24 months of age and product promotion in Kathmandu Valley, Nepal. Matern Child Nutr 12(Suppl 2):22–37. https://doi.org/10.1111/mcn.12267
Relvas GRB, Buccini GDS, Venancio SI (2018) Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of Sao Paulo, Brazil. J Pediatr (Rio J). https://doi.org/10.1016/j.jped.2018.05.004
Contreras M, Zelaya Blandon E, Persson LA, Ekstrom EC (2016) Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua. Matern Child Nutr 12(1):164–176. https://doi.org/10.1111/mcn.12144
Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada M, Cannon G (2018) Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr 21(1):18–26. https://doi.org/10.1017/s1368980017001379
Stimming M, Mesch CM, Kersting M, Libuda L (2015) Fish and rapeseed oil consumption in infants and mothers: dietary habits and determinants in a nationwide sample in Germany. Eur J Nutr 54(7):1069–1080. https://doi.org/10.1007/s00394-014-0784-y
European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies (2009) Scientific Opinion: Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. 7(12):1423. https://www.efsa.europa.eu/en/efsajournal/pub/1423
Fidler Mis N, Braegger C, Bronsky J, Campoy C, Domellof M, Embleton ND, Hojsak I, Hulst J, Indrio F, Lapillonne A, Mihatsch W, Molgaard C, Vora R, Fewtrell M (2017) Sugar in infants, children and adolescents: a position paper of the european society for paediatric gastroenterology, hepatology and nutrition committee on nutrition. J Pediatr Gastroenterol Nutr 65(6):681–696. https://doi.org/10.1097/mpg.0000000000001733
Netzwerk Gesund ins Leben (2018) Reif fuer die Beikost. https://www.gesund-ins-leben.de/inhalt/brei-fahrplan-29435.html. Accessed 1 Jan 2019
Werkgroep Voeding van de Vlaamse Vereniging Kindergeneeskunde (2012) Richtlijnen over borstvoeding en kunstvoeding voor zuigelingen van 0 tot 12 maand. https://www.kindengezin.be/img/consensus130625.pdf. Accessed June 20 2018
Conseil Supérieur de la Santé (2016) Recommandations nutritionnelles pour la Belgique 2016. Conseil Supérieur de la Santé, Brussels
L’Office de la Naissance et de l’Enfance (2000) The Nouveaux Aliments en Douceur. Brussels. http://www.qualitedelavie.be/spip9/Des-petits-plats-pour-les-grands-l,583
Davanzo R, Romagnoli C, Corsello G (2015) Position Statement on Breastfeeding from the Italian Pediatric Societies. Ital J Pediatr 41:80. https://doi.org/10.1186/s13052-015-0191-x
Alvisi P, Brusa S, Alboresi S, Amarri S, Bottau P, Cavagni G, Corradini B, Landi L, Loroni L, Marani M, Osti IM, Povesi-Dascola C, Caffarelli C, Valeriani L, Agostoni C (2015) Recommendations on complementary feeding for healthy, full-term infants. Ital J Pediat 41:36. https://doi.org/10.1186/s13052-015-0143-5
Società Italiana di Neonatologia (2002) Raccomandazioni sull’allattamento materno per i nati a termine, di peso appropriato, sani. Medico e Bambino 21:91–98
Szajewska H, Socha P, Horvath A, Rybak A, Dobrzańska A, Katarzyna M, Borszewska-Kornacka Chybicka A, Czerwionka-Szaflarska M, Gajewska D, Helwich E, Książyk J, Mojska H, Stolarczyk A, Weker H (2014) Nutrition of healthy term infants. Recommendations of the Polish Society for Paediatric Gastroenterology, Hepatology and Nutrition. Standardy Medyczne/Pediatria T. 11:321–338
Ksiazyk J, Rudzka-Kantoch Z, Weker H (2001) Feeding plan for breast-fed infants and non-breast-fed infants. Medycyna Praktyczna Pediatria 5(5):1–2
Ksiazyk J, Rudzka-Kantoch Z, HW (2001) Zalecenia zywienia niemowlat. Standardy Medyczne 7/8(3):10–16
Almarza AL, Martinez BM (2001) Alimentacion del lactante sano: Protocolos diagnóstico-terapéuticos de Gastroenterología, Hepatología y Nutrición Pediátrica SEGHNP- Asociacion Espanola de Pediatria, pp 287–295. https://www.aeped.es/sites/default/files/documentos/alimentacion_lactante.pdf
Schiess SA, Grote V, Scaglioni S, Luque V, Martin F, Stolarczyk A, Vecchi F, Koletzko B, European Childhood Obesity P (2010) Intake of energy providing liquids during the first year of life in five European countries. Clin Nutr 29(6):726–732. https://doi.org/10.1016/j.clnu.2010.04.003
Pawellek I, Grote V, Theurich M, Closa-Monasterolo R, Stolarczyk A, Verduci E, Xhonneux A, Koletzko B (2017) Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age. Eur J Clin Nutr 71(1):25–32. https://doi.org/10.1038/ejcn.2016.206
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.
Conflict of interest
The authors declare that they have no conflict of interest.
About this article
Cite this article
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). https://doi.org/10.1007/s00394-019-02023-3
- Complementary feeding
- Commercial complementary foods
- Baby foods