Rise of commercial complementary foods and implications on child health

For infants and young children, the WHO recommends introducing safe and nutrient-rich foods when breast milk or milk formula alone are no longer meet nutritional requirements of growing infants. This period, known as complementary feeding, starts at the age of 6 months and continues up to 2 years of age or beyond, with continued breastfeeding. It is a critical period that can influence the short and long-term health outcomes of infants and young children.

Over the last decade, there has been substantial global growth in the CACF market, retail sales increased by around 20% from 2019 to 2023. The growth differs across regions as almost 30% volume growth has been in Asia and Pacific regions and 10% in European region in the past 5 years.

ATNI research and objectives

In 2020, ATNI used the draft version of WHO Europe’s nutrient profiling model for CACF in conducting an assessment of CACF in the Philippines. Following this research, ATNI along with its partners of COMMIT used a version of WHO Europe’s draft model to assess CACF in seven Southeast Asian countries.

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For the present study, ATNI used the 2022 WHO Nutrient and Promotion Profile Model (NPPM).

The primary objective of this research is to increase the body of evidence on the nutritional quality and labeling practices of CACF, ensuring that more countries across different regions are covered. The results of this research complement the assessment and scoring of the BMS and CF Indexes that ATNI published in 2024. The research will also be considered in updating the methodology for future ATNI Indexes.

Read the full report here

Six companies, who contributed to over 40% of global CACF retail sale estimates in 2021, were selected for the assessment. The countries or markets to include in the research were selected based on the presence of these six companies, where the companies’ CACF shares are high.

To aim for regional representation, at least one country from each of the following WHO regions was selected: the Americas, Eastern Mediterranean, Europe, and South-east Asia. An additional requirement was the availability of data about the companies’ CACF products sold in a country.

Company shares of the global CACF market in 2021
Overall results

Results of the combined assessment of CACF nutrient composition and labeling practices

None of the companies’ CACF products met all requirements of the NPPM, for both nutrient composition and labeling. Therefore, based on the NPPM none of the CACF are suitable for promotion to infants and young children between six months up to three years of age.


Results on nutrient composition requirements

Almost 35% of assessed CACF met all nutrient composition criteria. Most companies’ CACF met the NPPM requirements for fat, fruit content, sodium, and protein. Most companies scored low on the requirement related to energy density. Around 70% of relevant CACF had appropriate energy levels to ensure provision of adequate nutrition.

Read the full report here

Results on labeling requirements

None of the companies’ CACF met the requirements relating to claims, as all products had at least one type of claim (nutritional, health or promotional). None of the puréed CACF met the recommended upper age limit of 12 months either

Recommendations for companies

• Companies selling CACF products are encouraged to adopt the most comprehensive existing
guidance on the nutritional composition and labeling of CACF. WHO Europe’s nutrient and
promotion profiling model for CACF is the only currently existing and widely recognized model
for CACF requirements (see pages 8 and 9 of the NPPM for specific guidance for companies).
• Companies should also continuously strive to improve their CACF products in line with relevant
developments in national, regional, and global guidance.

• Companies are urged to improve energy density levels of their CACF to meet NPPM thresholds
and follow the WHO recommendation which states “Manufacturers should be encouraged to
reduce and declare the water content of products to increase energy density and quality of soft
foods and purées. Setting a minimum energy density of 60 kcal /100 g for many purées will
also encourage manufacturers to add less water for cooking and blending and will therefore
ensure higher quality and better value products.”

Recommendations for policy makers

• Policymakers should develop new, or update existing, national regulations on the nutrient
composition and labelling practices of CACF, in line with international guidance. These 60 regulations should prohibit the use of added sugars and sweeteners, limit sugar and sodium content and outlaw the use of misleading marketing and labelling practices.
• Governments should establish a system for monitoring and evaluating national regulations on

Recommendations for investors

• Investors are encouraged to make use of existing nutrition frameworks such as ATNI’s Investor Expectations on Nutrition, Diets and Health and to integrate nutrition into responsible
investment strategies.
• Investors can use the findings of this report to drive companies’ progress on CACF nutrition
through various investment strategies, calling for transparency and adherence to the NPPM.
• Investors can use the data from this report to develop materials to support engagement with

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