Ultraprocessed food, additives prevalent in infant products sold in Southeast Asia

Several products in the Southeast Asia (SEA) region that are being marketed for infants and young children are considered ultraprocessed and contain certain additives, reveals a recent study. In addition, many of these additives are banned by Codex Alimentarius.

The Codex Alimentarius is a set of internationally recognized standards, codes of practice, guidelines, and other recommendations relating to food, food production, food labelling, and food safety. It is published by the Food and Agriculture Organization of the United Nations. [https://www.fao.org/fao-who-codexalimentarius/en/]

“Considering the growing evidence on the impact of ultraprocessed food (UPF) consumption on health and nutrition outcomes, as well as the potentially deleterious effects of certain additives, this study holds concerning implications for the diets of older infants and young children,” the authors said.

This cross-sectional study assessed the levels of processing among commercially produced complementary food product (CPCF) categories marketed in the SEA region, compared the nutrient content of CPCF products across levels of processing, and examined the types of additives present in various CPCF categories.

A secondary analysis was carried out on a cross-sectional dataset of product label information from CPCF purchased in 2021 in Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Thailand, Vietnam, and the Philippines.

The authors reviewed the ingredient lists to determine the level of processing—based on the Nova classification—and the presence of additives. Finally, they reviewed the nutrient declaration panels to evaluate the total sugar, sodium, and total fat content of products.

Based on the analyses, almost half of all CPCF were ultraprocessed, with total sugar and sodium content being significantly higher than unprocessed/minimally processed products. Nearly half of CPCF also contained additives, with a median of six additives per product. [Am J Clin Nutr 2024;120:310-319]

Cosmetic additives

In addition, cosmetic additives were used in more than 30 percent of all CPCF to enhance the appearance, flavour, or texture of these products. The most common cosmetic additives used were colours, emulsifiers, and thickeners. Notably, nearly a third of products had additives that are not permitted in Codex Alimentarius standards and guidelines for CPCF.

“The use of some additives in food products is not inherently a concern for [the health of young children], as many additives are not known to hold negative consequences for health, and their appropriate use can aid food preservation and safety,” the authors said. [Agric Food Secur 2017;6:1-22]

“However, increasing evidence has shown that some types of additives, particularly those used for cosmetic rather than functional purposes, may have negative implications for human health and nutrition outcomes,” they added.

The large amount of CPCF in this study suggests that the diet of infants and young children in the SEA region are becoming more highly processed. [Global Health 2016;12:80]

Previous studies have noted the association of UPF consumption with adverse health and nutrition outcomes, such as weight gain, cardiovascular disease, and increased risk of other diet-related noncommunicable diseases. [Am J Clin Nutr 2016;104:1433-1440; Obes Rev 2019;20:10-19; PLoS One 2020;15e0232676; Clin Nutr 2021;40:3608-3614; BMJ 2019;365:l1451]

“These findings should alert national governments to the urgent need to both adopt and ensure enforcement of Codex guidance on additives and regulations enacted to encourage lower levels of processing for CPCF,” the authors said.