Objective: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels. Design: Descriptive statistics of trends and patterns in MF sales volume per infant/ child for the years 2008-2013 and projections to 2018, using industry-sourced data. Setting: Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations. Subjects: MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months). Results: In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/ child was positively associated with country income level although with wide variability between countries. Conclusions: A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems. Keywords Infant and young child feedingNutrition transition Formula Breast-milk substitutes Breast-feeding is important for infant and young child health and development, and for maternal health, in both developed-and developing-country settings (1)(2)(3) . It is ranked as the single most effective intervention for the prevention of deaths in children under 5 years of age (4) . To achieve optimal growth, development and health the WHO recommends that infants should be exclusively breast-fed for the first 6 months of life and thereafter receive nutritionally adequate and safe complementary foods while continuing breast-feeding for up to 2 years of age or beyond (5,6) . Although significant progress has been made in some countries, the global exclusive breast-feeding rate improved only marginally from 33 % in 1995 to 37 % in 2014 (7) . Every year an estimated 823 000 deaths, or 13·8 % of total deaths, in children under 2 years of age would be prevented if breast-feeding were scaled up to a near-universal level in high-mortality low-and middleincome countries. For mothers, a universal level of breastfeeding in all countries would prevent an estimated 20 000 deaths from breast cancer annually (8) . Suboptimal infant and young child feeding (IYCF) also incurs higher health system expenditures through increas...

BackgroundIncreased global demand for imported breast milk substitutes (infant formula, follow-on formula and toddler milks) in Asia, particularly China, and food safety recalls have led to shortages of these products in high income countries. At the same time, commodification and trade of expressed breast milk have fuelled debate about its regulation, cost and distribution. In many economies suboptimal rates of breastfeeding continue to be perpetuated, at least partially, because of a failure to recognise the time, labour and opportunity costs of breast milk production. To date, these issues have not figured prominently in discussions of food security. Policy responses have been piecemeal and reveal conflicts between promotion and protection of breastfeeding and a deregulated trade environment that facilitates the marketing and consumption of breast milk substitutes.DiscussionThe elements of food security are the availability, accessibility, utilization and stability of supply of nutritionally appropriate and acceptable quantities of food. These concepts have been applied to food sources for infants and young children: breastfeeding, shared breast milk and breast milk substitutes, in accordance with World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) guidelines on infant feeding. A preliminary analysis indicates that a food security framework may be used to respond appropriately to the human rights, ethical, economic and environmental sustainability issues that affect the supply and affordability of different infant foods.SummaryFood security for infants and young children is not possible without high rates of breastfeeding. Existing international and national instruments to protect, promote and support breastfeeding have not been implemented on a wide scale globally. These instruments need review to take into account the emerging trade environment that includes use of the internet, breast milk markets and globalised supply chains for breast milk substitutes. New approaches are required to handle the long-standing policy conflicts that surround infant and young child feeding. Placing breastfeeding in a food security framework may achieve the political attention and policy co-ordination required to accelerate breastfeeding rates in a range of economies.

Background Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. Methods Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims. Results 276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of ‘no added sugar’ were made for 59% of pouches, despite the addition of free sugars. Conclusions Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0–36 months and better inform parents.

Our dominant food system is a primary driver of worsening human and planetary health. Held in March 2022, the Public Health Association of Australia’s Food Futures Conference was an opportunity for people working across the food system to connect and advocate for a comprehensive, intersectoral, whole-of-society food and nutrition policy in Australia to attenuate these issues. Conference themes included food systems for local and global good; ecological nutrition; social mobilisation for planetary and public good; food sovereignty; and food equity. Students and young professionals are integral in transforming food systems, yet are under-represented in the academic workforce, across publishing, scientific societies, and conference plenaries. A satellite event was held to platform initiatives from early career researchers in areas integral for improving planetary and public good. The research topics discussed in this commentary reflect sub-themes of the conference under investigation by early career researchers: food systems governance and regulation; local food policies; commercial determinants of health; sustainable healthy diets; and food equity and sovereignty.

Background Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy. Methods: Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims.Results: 276 products from 15 manufacturers were analysed, targeting infants from 4+ to 12+ months. Total sugar content ranged 0.8-17.5 (g/100g), 20% (n=56) of products had added sugars, 17% (n=46) had added fruit juice, 71% (n= 196) had added fruit puree. Saturated fat content ranged from 0.0-5.0 (g/100g), sodium 0.0-69 (mg/100g) and dietary fibre 0.0-4.3 (g/100g). Only two products achieved an NPI score indicating nutritional adequacy. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of ‘no added sugar’ were made for 59% of pouches, despite the addition of free sugars.Conclusions Squeeze pouch products available in Australia are nutritionally poor, high in sugars, low in iron, and there is a clear risk that if infants are fed regularly these products their health will be harmed. The marketing messages and labelling on squeeze pouches are highly misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0-36 months and better inform parents.