Gerber products aim to introduce infants to food and encourage the development of healthy eating habits [57]. Some children may be normal small because everyone in the family has always been small (genetic programs at work), while a wide range of causal pathways that may pathologically inhibit growth (including but not limited to nutrition, disease, or eating behaviors) can result in an individual being smaller than would be the case in the absence of these conditions. Prepared from the milk of cows, sheep, goats, or other constituents of plant origin, both FUFs and GUMs may have modified protein content and composition, in addition to a range of added nutrients (e.g., fatty acids, micronutrients, probiotics, prebiotics, or synbiotics) [14]. It is worth considering what role product marketing should be playing in the transmission of health-based information to the public. Fisberg M., Mauln-Radovn I., Tormo R., Carrascoso M., Giner C., Martin F., Belinchn P.P., Costa C.M., Prez M., Caro J.G., et al. The samples were certainly not kids generically, but those whose initial conditions were associated with known unique physiologies. Global Baby Care Report. On these charts, normal size for age has a wide range and is generally interpreted as sizes falling between the 5th or 10th and 90th or 95th percentiles (or 3rd and 97th, by way of the WHO standards), with the caveat that, by definition, some people are among the statistically relatively small (the 90th, 95th, or 97th percentiles). Available online: Mead Johnson 2015 Annual Report Form 10K United States Securities and Exchange Commission. Three interventions that reduce childhood obesity are projected to save more than they coast to implement. This results in easily readable interpolations of the relative size of children at each age, but does not record the actual paths by which individuals grow across time [30,31]. Increased scientific scrutiny and oversight of such claims are needed for the well-being of our youngest citizens. This is often captured by body mass index (BMI), a type of morphological expansion not equivalent to increase in overall skeletal size, the process that takes individuals from infant dimensions to adult height. In contrast to this maturationally based support of food introduction, the emergence of infant liquid supplements targeting the time of weaning and complementary food acquisition aims to continue the developmentally earlier reliance on liquids. Bier D.M. What parent would not consider a product that promises to help kids grow [24]? This framework was further enhanced by the Food and Drug Modernization Act (FADMA) in 1997, which permitted structure/function claims to be included in marketing, with terms such as support, promote, and maintain allowable in statements linking a products role in maintaining normal function, with the caveat that consumers must have a reasonable expectation of no harm [104]. The reality is that the products are being consumed as food and the supplementary feedings are associated with weight gain, which is neither growth nor healthy. Walker S.P., Golden M.H. Infant Feeding Survey 2010. Growth Chart. Moreover, the International Code provided additional provisions to protect vulnerable populations or groups that are more likely to succumb to advertising campaigns due to increased exposure in the marketplace, less education, or less experience [98]. Size is not growth. [(accessed on 2 October 2016)]. [(accessed on 1 October 2016)]. Clinically documented under- and malnourished children. Reassessing the evidence for and relevance of dietary supplements promoting healthy growth claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. As observational studies cannot prove causality, and the two studies described as randomized control trials (RCTs) did not actually randomize for the product itself, these studies are all merely observational. Examples of such ingredients include long-chain polyunsaturated acids such as docosohexanoic acid (DHA) and arachidonic acid (ARA), which have been postulated to be on the causal pathway of enhanced intellectual development among breastfed versus formula-fed infants [105,106]. Individuals under the 3rd or 5th-percentile for age, for example, do not share a common set of conditions. The study protocol involved offering two daily servings (240 kcal each) of a 1 kcal/mL supplement, or 480 additional daily kcal, for 48 weeks. While this may not be a legal breach, perhaps it is time to question whether this makes it an acceptable practice and if further oversight might be beneficial. In fact, follow-on formula began to be promoted more aggressively following the introduction of the International Code, as demonstrated by the publication of the first standard for follow-on formula composition, also in 1981 [102]. While there are no doubt acute events that compromise nutritional intake and lead to severe weight loss from which children may benefit from a rapid turn-around in weight gain, these are likely to necessitate pediatric oversight and are not appropriately resolved by direct marketing products. While getting bigger in terms of weight gain may be instrumental in reducing risk of mortality among infants in the neonatal intensive care unit or those recovering from severe malnutrition [22], it may augment health risks among individuals in alternative conditions [33]. All of this would appear to be well aligned with efforts to properly inform the public in decision-making. Rapid infancy weight gain and subsequent obesity: Systematic reviews and hopeful suggestions. The most commonly used parameter, weight, is not actually a growth proxy at all [32]. In: Makrides M., Ochoa J.B., Szajewska H., editors. Thus, in addition to individual level health consequences, public health issues are also at stake. 4325.108 Stat. The problem here is that this is not biologically accurate and, thus, the premise on which the study design was based is incorrect. As a principle of growth during development is increase in size across time, it is important to specify what is increasing. Body size and growth in 04-year old children and the relation to body size in primary school age. National Center for Health Statistics; 2016. Clarifying the nature of the evidentiary base on which structure/function claims promoting healthy growth are constructed is important to curb invalid generalizations. Dynamics of childhood growth and obesity: Development and validation of a quantitative mathematical model. The operative word here is misleading. 8600 Rockville Pike The opposite can also occur, with relatively large neonates slowing down their growth rates after birth. 10-1421, 4/20/11) [(accessed on 1 October 2016)]; Kuczmarski R.J., Ogden C.L., Guo S.S., Grummer-Strawn L.M., Flegal K.M., Mei Z., Curtin L.R., Roche A.F., Johnson C.L. This phenomenon occurs among adults who have completed their physical growth, and may increase plumpness, or weight-for-height. Gerrish C.J., Mennella J.A. Global trends and patterns of commercial milk-based formula sales: Is an unprecedented infant and young child feeding transition underway? A rapid size increase, compared to peers of similar age, translates to a relatively larger size and a correspondingly higher percentile of size-for-age. Weight gain or loss represents the balance between energetic intake and utilization, and the consumption of calories above that which can be used accrues as body fat. Severe malnutrition is accompanied by pathophysiologic and adaptive changes that raise unique feeding challenges for nutritional rehabilitation. Despite the positive intentions of the international code, the United States has not taken steps to implement it. Lampl M., Thompson A.L. After 8 to 35 days of feeding, 13 children suffering from kwashiorkor gained weight, and after 2.4 months of feeding an unspecified amount of the target product, nine 640-month-old children recovering from protein-energy malnutrition weighed more and were longer [38] . The most significant piece of legislation that created boundaries on the advertising and use of these products was the International Code of Marketing of Breast-Milk Substitutes [97]. The semantic paraphrasing in many marketing pitches is more than a packaging issue and more than puffing. Protein requirements of infants and children: Growth during recovery from malnutrition. In fact, rapid infant growth among the relatively small predicts rising chronic disease risks among adults [1,3,4,5,9,25]. Food Nations. Fat thickness and developmental status in childhood and adolescence. It is a number one Clinically proven health product that helps kids to grow. Gluckman P.D., Hanson M.A. Akram D.S., Bharmal F.Y., Hussain T. PediaSure. Simply becoming bigger across time provides no evidence of product-specific efficacy. This is quite apart from the fact that the Z-score reference employed, the CDC data base [51], does not actually include data from infants within the age range of the study sample, and that the validity of the mean result across 10 study subjects is a questionable outcome, as some individuals were characterized by increasing and others by decreasing Z-scores across time [48]. At older ages, marketing that suggests busy parents may appreciate that liquid supplements can be used as a childs quick breakfast as a great way to help them grow [113] directly takes the items out of their protected status as supplements and into usage as food. Individual growth biology does not unfold like this. 4325.03-417, United States Congress. The latter group gained more weight and height than the unsupplemented, counseled group. [(accessed on 1 October 2016)]. Successful parent-directed marketing of infant and young child food products is embodied by the iconic Gerber baby image trademarked in 1931, a brand that remained synonymous with trustworthiness and quality as demonstrated by higher reported consumer loyalty than any other commercial brand in the United States in 2002 [55]. Zero subjects means no actual data, hence no information on the size of actual children. Assault on the gut microbiome. Draft Guidance for Industry: Factors that Distinguish Liquid Dietary Supplements from Beverages, Considerations Regarding Novel Ingredients, and Labeling for Beverages and Other Conventional Foods. This removes any overt culpability on the part of the product providers for consumers choosing to purchase the product. National Library of Medicine Special Advertising Section. Augmenting rapid growth among infants and young children is not merely a risk to the global burden of obesity. Jackson L.A., Ervin K.S. As exposure to these products rises, this may not be a small indiscretion. These types of trust-engendering statements may not be needed to sell a particular product, but they are important to build trust in the brand. Copyright 2022 Ubuy Co. All rights reserved. Pediasure is known for aiding growth and development in kids. The escalating use of follow-up formulas globally includes provision to infants younger than national legislation and international recommendations, without best practices for basic hygiene, raising safety concerns for infants under two months of age [63]. US Library of Medicine. Fryar C.D., Ogden C.L. Thirty-Eighth Session. 2010. Prevalence of Underweight among Children and Adolescents Aged 219 Years: United States, 19631965 through 20132014. Doses ranged from a 14-day intervention among children who consumed the product according to demand and tolerance while also receiving breast milk [35] to a provision of at least 90% of all daily nutrition needs for 12 weeks [39]. Delivery time may vary depending on store and country. One might ask, why do any of these details matter? Shifts in percentiles of growth during early childhood: Analysis of longitudinal data from the California Child Health and Development Study. Following the rise in the adult liquid nutritional supplement markets, perhaps this infant product development and expansion is not surprising. A number of fortified beverages are predominantly targeted for the transition and weaning periods, with FUFs developed for children from six months of age as part of the weaning diet and GUMs, or toddler milks, intended for children from one to three years of age. Ubuy provides its products from 7 international warehouses located in the UK, USA, China, etc to over 180 countries worldwide at affordable prices. Shamir R., Shehadeh N. Insulin in human milk and the use of hormones in infant formulas. Statista. After four months intake, the average weight-for-height changed an average of 10 percentiles among 626 children who were 1 to 3 SDs below the median weight-for-height at study onset [37]. Chronically disabled children who require specialized nutritional support and total enteral support by oral or nasogastric feeding. Lampl M., Mummert A. Additional problematic aspects of oversight involve the inclusion of functional ingredients in toddler milks with the intent of targeting specific biological effects. It is a clinically proven product that comes with complete balanced nutrition. ESPGHAN Committee on Nutrition Guidelines on infant nutrition II. This is taking place with a relative lack of marketing regulation. Two words merit close consideration: proven and kids. The original target for a number of liquid supplementation products was clinically small individuals for whom smallness was associated with health risks. Recommendation for the composition of follow-up formula and Beikost. The Politics of Breastfeeding: When Breasts Are Bad for Business. After 14 days, 30 of 40 severely malnourished Pakistani children aged 1 to 5 years gained weight and accrued fat [35]. Lazzerini M., Rubert L., Pani P. Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries. Identifying the parameters of normal growth scientifically has been based primarily on descriptive criteria, emanating from the work of auxologists, scientists who study the size of childrenmeasuring them, calculating descriptive statistics by age, and devising both tables and graphical images of size-for-age so that the relative size among peers of similar background and sex may be quickly appreciated [44,45]. Often referred to as follow-up formula (FUF), growing-up milk (GUM) or toddler milks, these liquid-based nutritional supplements have great similarity to infant formulas, but are intended to function as meal complements rather than meal replacements [14]. The developmental origins of the metabolic syndrome. As the work of David Barker and numerous scientists have demonstrated, a legacy of generations of undernutrition is relative smallness at birth [1], and the use of calorically-dense supplements to help such children grow in infancy may be a distinctly unhealthy effort [120,121]. In the interest of advancing oversight of these products and their consumption patterns a series of action steps will be beneficial: (1) Scientists need to continue their efforts to refine methods permitting the identification of sources and consequences of childhood overweight [114]; (2) clinicians and other healthcare professionals need to play a more substantial role in helping parents assess the validity of product health claims; this may involve educating pediatricians on the science behind the products and their biological effects [115]; and (3) public health and policy professionals need to continue integrating early development of overweight into the larger context of health [116] and consider this specific dietary area and behavior pattern as part of the long-term obesity prevention and reduction agenda [117].
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