World Journal of Dentistry

Register      Login

VOLUME 14 , ISSUE 3 ( March, 2023 ) > List of Articles

ORIGINAL RESEARCH

Variability of Sugars Concentrations in Infant Follow-on Formulas with Higher Consumption in Peru: A Preliminary Study

Angélica K Munives-Marcos, Carlos J Arauzo-Sinchez, Ana C Cupé-Araujo, Marysela I Ladera-Castañeda, Luis A Cervantes-Ganoza, César F Cayo-Rojas

Keywords : Carbohydrates, Dental caries, Diet, Infants, Infant formula, Preliminary study, Sucrose, Sugars

Citation Information : Munives-Marcos AK, Arauzo-Sinchez CJ, Cupé-Araujo AC, Ladera-Castañeda MI, Cervantes-Ganoza LA, Cayo-Rojas CF. Variability of Sugars Concentrations in Infant Follow-on Formulas with Higher Consumption in Peru: A Preliminary Study. World J Dent 2023; 14 (3):201-206.

DOI: 10.5005/jp-journals-10015-2199

License: CC BY-NC 4.0

Published Online: 05-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: The aim of the present preliminary study was to determine sugar concentration in infant follow-on formulas most widely consumed in Peru. Materials and methods: In this descriptive and observational study, the sample was represented by five brands of infant follow-on formulas most consumed in Peru (A, Similac 2; B, Enfamil 2®; C, NAN 2®; D, Baby Lac Pro 2®; and E, Lacti Kids Premium 2®); with two samples of each, collected at two different locations in the Peruvian capital. Subsequently, the concentration of total and individual sugars (lactose, sucrose, glucose, fructose, and maltose) was determined using the high-performance liquid chromatography (HPLC) method in a specialized laboratory. For the comparison of means, Welch's robust analysis of variance (ANOVA) test for equality of means and Tukey's post hoc test were used. The significance level was p < 0.05. Results: The total sugars concentration per 100 gm of the five infant follow-on formulas showed a mean of 38.9 ± 11.03 gm, being Similac 2, the infant follow-on formula, with the highest concentration of 50.33 ± 0.11 gm and Enfamil 2, the lowest with 22.75 ± 0.06 gm. The average sugars recorded in the laboratory were compared with those on the product label for Similac 2 (50.3 and 53.1 gr), NAN 2 (46.5 and 51.5 gr), Baby Lac Pro 2 (41.5 and 57.0 gr), Lacti Kids Premium 2 (33.3 and 57.0 gr) and Enfamil 2 (22.8 and 56.0 gr). Furthermore, when comparing the infant follow-on formulas, significant differences were observed between all sugar concentrations (p < 0.001), with the follow-on formula with the significantly higher sugar concentration being Similac 2 (p < 0.001) and the one with the significantly lower concentration being Enfamil 2 (p < 0.001). Regarding individual sugars, per 100 gm analyzed, fructose and maltose registered values <0.70 g. Similar values were obtained for glucose except for Enfamil 2 (1.07 ± 0.01gr) and Baby Lac Pro 2 (0.72 ± 0.01gr) and for sucrose except for Lacti Kids Premium 2 (11.92 ± 0.01gr) and Similac 2 (9.94 ± 0.08 gr). On the other hand, the highest lactose value found was in NAN 2 (46.51 ± 0.08 gr), and the lowest value obtained was in Lacti Kids Premium 2 (21.42 ± 0.01 gr). Conclusion: There is a variability of sugar concentrations in infant follow-on formulas, being these values lower than those referred to on product labels. The formula with the lowest discrepancy was Similac 2, while the formula with the highest discrepancy was Enfamil 2, with Similac 2 and Enfamil 2 being significantly the formulas with the highest and lowest sugar concentration, respectively. In addition, among individual sugars, lactose, and sucrose stood out in greater proportion compared to other free sugars. Clinical significance: It is important that institutions responsible for infant nutritional safety encourage and promote the use and practice of breastfeeding during early life and provide adequate guidance regarding daily doses of infant follow-on formulas since, according to the World Health Organization (WHO), the high consumption of free sugars contained in these formulas can put infants’ oral health at risk.


PDF Share
  1. Vitolo MR. How much free sugars intake should be recommended for children younger than 2 years old? J Pediatr Gastroenterol Nutr 2018;66(3):e87. DOI: 10.1097/MPG.0000000000001802
  2. Walker RW, Goran MI. Laboratory determined sugar content and composition of commercial infant formulas, baby foods and common grocery items targeted to children. Nutrients 2015;7(7):5850–67. DOI: 10.3390/nu7075254
  3. Frades PA, Royo MÁ. Nutrient composition and sugar content of dairy products targeting young children in supermarkets. Rev Pediatr Aten Primaria 2018; 20(80):353–363. [Accessed May 13, 2022]. Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1139-76322018000400004
  4. Westerfield KL, Koenig K, Oh R. Breastfeeding: common questions and answers. Am Fam Physician 2018;98(6):368–373. [Accessed May 13, 2022]. Available from: https://www.aafp.org/dam/brand/aafp/pubs/afp/issues/2018/0915/p368.pdf
  5. Tan SF, Tong HJ, Lin XY, et al. The cariogenicity of commercial infant formulas: a systematic review. Eur Arch Paediatr Dent 2016;17(3):145–56. DOI: 10.1007/s40368-016-0228-x
  6. Martin CR, Ling PR, Blackburn GL. Review of Infant feeding: key features of breast milk and infant formula. Nutrients 2016;8(5):279. DOI: 10.3390/nu8050279
  7. Green Corkins K, Shurley T. What's in the bottle? A review of infant formulas. Nutr Clin Pract 2016;31(6):723–729. DOI: 10.1177/0884533616669362
  8. Zhang K, Tang L, Wang H, et al. Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff. Int J Environ Res Public Health 2015;12(5):4520–4532. DOI: 10.3390/ijerph120504520
  9. De Lauzon-Guillain B, Davisse-Paturet C, Lioret S, et al. Use of infant formula in the ELFE study: the association with social and health-related factors. Matern Child Nutr 2018;14(1):e12477. DOI: 10.1111/mcn.12477
  10. National Institute of Statistics and Informatics: Demographic and Family. Health Survey 2016, National and Regional, Peru. 2017 [Accessed Jun 23, 2021]. Available from: https://www.inei.gob.pe/media/MenuRecursivo/publicaciones_digitales/Est/Lib1433/index.html
  11. Chaudhary SD, Chaudhary M, Singh A, et al. An assessment of the cariogenicity of commonly used infant milk formulae using microbiological and biochemical methods. Int J Dent 2011;2011:320798. DOI: 10.1155/2011/320798.
  12. FidlerMis N, Braegger C, Bronsky J, et al. 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 2017;65(6):681–696. DOI: 10.1097/MPG.0000000000001733
  13. Moynihan P. Sugars and dental caries: evidence for setting a recommended threshold for intake. Adv Nutr 2016;7(1):149–156. DOI: 10.3945/an.115.009365
  14. Lagerweij M, van Loveren C. Chapter 7: sugar and dental caries. Monogr Oral Sci 2020;28:68–76. DOI: 10.1159/000455373
  15. Ministry of Health. Breastfeeding and Compliance with the International Code of Marketing of Breastmilk Substitutes Final monitoring report in Apurímac, Ayacucho, Huancavelica, Lima and Loreto, Lima-Peru, 2011. Available from: http://bvs.minsa.gob.pe/local/minsa/1710.pdf
  16. Cayo-Rojas CF, Santillán-Espadín KR, Nicho-Valladares MK, et al. Knowledge about oral health, salivary PH, body mass index and its relationship with dental caries in preschool children. Rev Fac Med 2021;69(4):e88709. DOI: 10.15446/revfacmed.v69n4.88709
  17. Giacaman RA. Sugars and beyond. The role of sugars and the other nutrients and their potential impact on caries. Oral Dis 2018;24(7):1185–1197. DOI: 10.1111/odi.12778
  18. Calvillo A, Cabada X, García K. Industrialized infant and young child feeding. The new mega business; 2013 [Accessed May 30, 2022]. Available from: https://elpoderdelconsumidor.org/wp-content/uploads/2013/02/Alimentaci%C3%B3n_industrializada_lactante_ni%C3%B1o_peque%C3%B1o_VF.pdf
  19. World Health Organization. WHO urges global action to curtail consumption and health impacts of sugary drinks. 2016(Accessed Jan 10, 2022). Available from: https://www.who.int/elena/titles/ssbs_childhood_obesity/es/
  20. Moynihan P. Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake. Adv Nutr 2016;7(1):149–146. DOI: 10.3945/an.115.009365
  21. Harton A, Myszkowska-Ryciak J. Types of milk and/or its substitutes are given to children (6–36 months) in nurseries in Poland: data from the research and education project “eating healthy, growing healthy”. Int J Environ Res Public Health 2018;15(12):1–11. DOI: 10.3390/ijerph15122789
  22. Ching C, Zambrano P, Nguyen TT, et al. Old tricks, new opportunities: how companies violate the international code of marketing of breast-milk substitutes and undermine maternal and child health during the COVID-19 pandemic. Int J Environ Res Public Health 2021;18(5):1–29. DOI: 10.3390/ijerph18052381
  23. Fewtrell M, Bronsky J, Campoy C, et al. Complementary feeding: a position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) committee on nutrition. J Pediatr Gastroenterol Nutr 2017;64(1):119–132. DOI: 10.1097/MPG.0000000000001454.
  24. Verduci E, D’Elios S, Cerrato L, et al. Cow's milk substitutes for children: nutritional aspects of milk from different mammalian species, special formula and plant-based beverages. Nutrients 2019;11(8):1–16. DOI: 10.3390/nu11081739
  25. Cayo-Rojas C, Gerónimo-Nieto E, Aliaga-Mariñas A. Salivary pH changes caused by cariogenic and non-cariogenic food intake in preschoolers from Huaura, Peru. Rev Cubana Estomatol 2021;58(4):e3518. [Accessed May 27, 2022]. Available from: https://revestomatologia.sld.cu/index.php/est/article/view/3518/2003
  26. Chaffee BW, Feldens CA, Rodrigues PH, et al. Feeding practices in infancy associated with caries incidence in early childhood. Community Dent Oral Epidemiol 2015;43(4),338–348. DOI: 10.1111/cdoe.12158
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.