Sugar and sodium content of baby foods in South Africa

Abstract

Introduction: The burden of non-communicable diseases (NCDs) in South Africa is growing and since 2010 the proportion of deaths due to NCDs relative to those due to communicable diseases has increased. Excessive sugar and salt consumption are associated with many of the risk factors for NCDs. Exposure to excess sugar and salt early in life affects subsequent eating behaviour, and creates a predisposition towards NCDs. The aim of this study was to describe and analyse the sugar and salt1 content and labels of commercially produced baby foods and infant formulas in South Africa and to compare these to current recommended intake guidelines; as well as to determine whether there is a relationship between the price of baby food and the sugar or salt variables over the study period (2015) Methods: This cross-sectional study was an analysis of the sugar and salt content of commercially available baby foods and formulas in South Africa using data collected from packaging and price. Photos were taken of labels, both of the front and back of the pack, including the nutritional table and ingredients list, and coded later. The sampling approach was purposive and after exclusions the sample was divided into: formula (n=53) and baby foods (n=283). The baby foods sample was fairly representative with 77% of the LBN brands included in the baby foods study sample. The formula study sample was fairly representative with 69% of LBN brands in the sample frame. Data on the sugar and salt content were compared to Elliott and Conlon (2015) recommended intake guidelines for salt and sugar. These recommended intake guidelines use dietary reference intakes from the US Institute of Medicine to set guidelines per serving for baby and toddlers. Dependent variables were created for sugar, salt and labelling. Bivariate analysis was used to determine if there were any associations between the dependent variables and the characteristics of baby food and formula and labelling variables including: manufacturer, formula type, food type, food subtype and target age. The two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to detect associations between the price of the baby foods and formulas and the dependent variables for sugar and salt. Results: The majority (96%) of baby foods (n=283) did not have added salt and were classified as having low-salt content. Although three quarters of baby foods had no added sugars, the sugar content due to lactose or fructose was high (78%). Cereals, snacks and desserts contained the most added sugar and had a high sugar content. There was an association between price and added sugar, with foods with added sugar having a lower median price. There was an association between price and added salt with the added salt category having a higher median price. The labels conformed to current standards, but did not have 1 For the purposes of this study we use the term sodium when referring to nutrients as all food packaging should detail sodium content on their nutritional table. When listed as an ingredient, salt is assumed to be sodium chloride. clear front-of-pack (FOP) information on levels or proportions of sugar or salt and whether there was any added salt or sugar. Conclusions: This is the first study in South Africa on the sugar and salt content of baby foods and/or formulas. More than three quarters of baby food products sampled had a high sugar content (more than 20% of total calories were derived from sugar) and almost a quarter of baby food products sampled (24.3%) contain added sugars. This creates an environment favourable to the development of sweet-taste preferences. There is a clear need for regulations around baby foods as a starting point for developing healthy eating behaviours in the South African population, which can help to reduce NCDs. Recommendations include interventions which are in line with the sub-strategy of the Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013-17, which aims to “Prevent NCDs and promote health and wellness at population, community and individual levels”. Additionally, these interventions tie into the more specific goals in detailed in the Strategy for Prevention and Control of Obesity (2015). These include: the creation of an environment which supports access to- and availability of- healthy food choices; the support of initiatives that aim to prevent obesity in early childhood; and communication aimed at the education and mobilisation of communities. Disclosure of added sugars should be enforced on packaging. An easy to understand front-of-pack (FOP) labelling system based on a traffic-light system would not only inform consumers about whether foods are healthy or not but would also most likely encourage manufacturers to revise sugar content of their products. Other considerations should include: providing guidance for parents/caregivers on feeding foods with high sugar content either through a media campaign such as posters in waiting areas; clear targeted messages in the Road to Health booklet on dangers of foods with high sugar content and education on how FOP traffic-light labelling works.