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]. As an interval of catch-up growth is normally found among such samples [22], all study designs represent sampling bias, which precludes identifying whether a specific feeding protocol is associated with subsequent increased body size. Despite their rule that disclaimers must be present describing the state of the evidence used to substantiate the statement, these laws placed the FDA in a reactionary rather than gate-keeper role regarding the truthfulness of claims for nutritional supplements. The infant liquid supplement industry is rapidly expanding globally at the expense of vulnerable populations. The childrens actual caloric consumptions during the study were estimated from 24-h recalls at the assessment points as an additional 270 kcal per day at four weeks, increasing by a further 136 kcal at eight weeks (for a mean 1786 kcal per day), followed by a plateau thereafter with attenuated increases to a total of 500 kcal above baseline at 48 weeks (an average of 1956 kcal per day). [(accessed on 1 October 2016)]. Closing the quality gap: Promoting evidence-based breastfeeding care in the hospital. If they did, prenatal growth rates would determine size for life and all children would have to grow at the same rates across time to maintain their sizes relative to one another (percentile rankings of size-for-age). Spotlight on infant formula: Coordinated global action needed. As a principle of growth during development is increase in size across time, it is important to specify what is increasing. 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. This long-standing brand offers a developmentally grounded product line, aligning biological indicators of motor development from birth through supported and independent sitting, crawling, walking, and preschool ages, with foods that change in texture, taste, and accessibility to match infants emerging skills. [37] offered the nutritional product with and without an added fortified synbiotic (which had no significant effect on the incidence of illness, number of sick days, or number of sick episodes); Alarcon et al. Stuart B., Panico L. Early-childhood BMI trajectories: Evidence from a prospective nationally representative British cohort study. Shehadeh N., Hanien A., Porat C., Shamir R., Eshkar-Sebban L., Devir M., Olshansky M., inventors; Nutrinia Ltd. , assignee. This can be better clarified by determining how an individual is smallin what dimension they are small and due to what process. A consequence of this includes erroneous assumptions regarding healthy growth, which in turn form a basis for invalid claims of efficacy. This is not without human consequences. The null hypothesis was that the natural growth of each infant is expected to remain on the same percentile; namely, the Z-score is expected to be stable during growth [48] and the effect of the supplemented feed was evaluated as the difference between the Z score at 6 months and that at birth [48]. Review of the Standard for Follow-Up Formula (CODEX STAN 156-1987). 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]. Accessibility [(accessed on 1 October 2016)]. The latter group gained more weight and height than the unsupplemented, counseled group. Ethical Issues in Research with Special Populations. World Health Organization Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children. Yes, Ubuy ships Pediasure products in the UK. Liquid nutritional supplement products among infants were, however, originally developed as a supplemental source of energy, proteins and/or specific nutrients for under- or mal-nourished children [16] and those diagnosed with failure to thrive (FTT), a non-specific diagnosis of growth failure stemming from a range of biological, psychosocial, and environmental factors [17]. UK. Substantial evidence identifies that this is scientifically questionable, if not indefensible. A closer look at the studies supporting one such product provides perspective on the importance of these specifics. Walker M. Formula supplementation of the breastfed infant. The challenges in any intervention aiming to promote bigger size among smaller children include, first and foremost, the definition of small. An increase in oversight going forward will involve assessing the accuracy of a number of product claims by clarifying the strength of the data upon which they are based and the assumptions upon which the interpretations rely. This improvement was a mean increase of 3.5 cm in height (a 0.12 Z-score change) by week 24 (accrued as 0.5, 0.7, 1.2, and 1.1 cm sequential increments at 4, 8, 16, and 24 weeks) and a weight-for-height Z-score (WHZ) change of 0.46 by week eight. Concerns about increasing weight without increasing skeletal size have been raised amongst human growth specialists since 1959 [10]. [(accessed on 1 October 2016)]. The decision regarding who may benefit from interventions for smallness is not necessarily simple. These include the predilection for high energy-density snacks, limited consumption of fruits and vegetables, and the development of obesity later in life [70]. Maternal perceptions of toddler body size accuracy and satisfaction differ by toddler weight status. Key features in all Pediasure products are: Pediasure products provide Complete Balanced Nutrition for your kid with proper physical and mental development. Now that supplements have entered the marketplace for children-at-large and the number of children consuming them during critical periods of growth continues to increase, it is essential to consider the evidentiary base supporting the health claim properties of liquid-based nutritional supplements. National Library of Medicine Barker D.J., Bagby S.P., Hanson M.A. 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]. Safety standards in infant nutrition: A United States perspective. 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. This is in spite of the fact that the World Health Organization has deemed such products unnecessary and potentially harmful to childrens long-term health. These reference data sources include the growth charts found among the working tools of clinicians, community health workers, and others involved in monitoring child health and well-being. The misappropriation of auxological terminology here (catch-up growth) leads to claims that are not evidence-based. Among 14 children, increased height, weight, and skinfold thickness was observed after 12 weeks of feeding the product, which provided 90% of daily nutrition in a nonrandomized study that lacked a control group [39]. These studies show that the interpretation of meaningful outcomes after interventions aiming to promote growth is an area in significant need of review, standardization, and oversight. 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. Energy gap in the aetiology of body weight gain and obesity: A challenging concept with a complex evaluation and pitfalls. Handbook of Growth and Growth Monitoring in Health and Disease. Interventions aiming to turn the tide and stimulate growth, and thereby development, can be seen as health promoting due to their associated decreased risks of morbidity and mortality. Statista. Following the rise in the adult liquid nutritional supplement markets, perhaps this infant product development and expansion is not surprising. Breastfeeding and later cognitive and academic outcomes. What parent would not consider a product that promises to help kids grow [24]? Available online: Adair L.S., Fall C.H., Osmond C., Stein A.D., Martorell R., Ramirez-Zea M., Sachdev H.S., Dahly D.L., Bas I., Norris S.A., et al. 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]. A study of marketing and its effect on infant feeding practices. These products are currently sold to a wide customer base in what was estimated in early 2016 to be the fastest-growing packaged food market globally [15]. Recovery from stunting revisited. 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]. Cole S.Z., Lanham J.S. Chronically disabled children who require specialized nutritional support and total enteral support by oral or nasogastric feeding. As clearly documented in 1976, infants do not remain at the same size percentiles from birth to six months of age [49]. David Barkers Developmental Origins of Health and Disease model (DOHaD) has led to the recognition of healthy growth as a cornerstone for lifespan health. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. [(accessed on 1 October 2016)]. Height stereotypes of women and men: The liabilities of shortness for both sexes. 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]. Available online: Suleiman A. McFadden A., Mason F., Baker J., Begin F., Dykes F., Grummer-Strawn L., Kenney-Muir N., Whitford H., Zehner E., Renfrew M.J. Increased scientific scrutiny and oversight of such claims are needed for the well-being of our youngest citizens. The special needs for recovery from malnutrition are further accompanied by a pattern of increased weight prior to, but not necessarily followed by, increased length growth [22]. For the average over-the-counter consumer, it is unclear why it is desirable for children to gain weight in just 8 weeks [78]. The authors declare no conflict of interest. Just get them online from Ubuy UK, which offers a huge range of Pediasure products at discount prices in UK. For the growth chart pictured on the web page, only size at birth comes from a large sample: the United States Vital Statistics (19681980; 19851994) provides data from more than 40 million boys and girls who were born over 1500 grams (healthy or not). This marketing strategy plays on well-documented perception errors of mothers regarding their childrens size [95] and is likely to exacerbate rather than alleviate the global child overweight and obesity trend. [(accessed on 2 October 2016)]; Food and Drug Administration Modernization Act of 1997. These online materials may also aim to educate consumers or support them in their interactions with their physicians by offering a translation of what the pediatrician might say during a consultation, for example. While the competitive supplement products try to out-do one another with proprietary claims, the nomenclature supplements circumvents much of the FDA oversight. Energy imbalance underlying the development of childhood obesity. Perhaps more importantly, this is a missed opportunity to educate the public. The health consequences of such practices should be more seriously considered. In fact, they are not designed to provide this information. Contrary to the conclusions of the authors, the data cannot describe catch-up growth [40,83] and do not describe saltation and stasis growth [46]. Altman D.G., Royston P. The cost of dichotomizing continuous variables. Nicklaus S., Boggio V., Chabanet C., Issanchou S. A prospective study of food variety seeking in childhood, adolescence and early adult life. Purchase a Pediasure product from Ubuy and have a chance to earn money by becoming Pediasure influencer with our Influencer Program. Relatively small individuals defined by low weight-for-age or weight-for-length samples. This phenomenon occurs among adults who have completed their physical growth, and may increase plumpness, or weight-for-height. Given the suggested suitability of some of these products for consumption between ages two and 13, it is yet to be seen what the consequences may be for child weight profiles globally in the coming years. The operative word here is misleading. To learn more about click here. Gortmaker S.L., Wang Y.C., Long M.W., Giles C.M., Ward Z.J., Barrett J.L., Kenney E.L., Sonneville K.R., Afzal A.S., Resch S.C., et al. All small infants and children are not, however, equal. [(accessed on 2 October 2016)]. Joint FAO/WHO Food Standards Programme Codex Committee on Nutrition and Foods for Special Dietary Uses. Bier D.M. It is time for the medical and scientific community to recognize the attention needed here on two levels. The intervention was associated with a total weight gain of 0.5 kg after four weeks, 0.8 kg at eight weeks, and 0.2 to 0.3 kg per eight weeks thereafter, for a total accrual of 2.2 kg at 48 weeks. While there may be no reason for a marketing team to be experts in human growth, it appears to be time for more validity oversight. Alarcon P.A., Lin L.H., Noche M., Jr., Hernandez V.C., Cimafranca L., Lam W., Comer G.M. Working Mother Sep. 2004. These include fluid, electrolyte, mineral and vitamin imbalances, and issues of gastrointestinal absorption, immune competence, and thermal regulation that alter nutritional needs during recovery [18,19,20,21]. The Politics of Breastfeeding: When Breasts Are Bad for Business. Gerrish C.J., Mennella J.A. A review of 25 studies identified increasing z-scores in weight gain between one and four years of age to be significantly associated with increasing BMI, adiposity, and percent body fat in mid-childhood [90].
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