Commercial interests driving standards for formula milk

Editorial: Standards for infant milk formula; BMJ Volume 332, pp 621-622

Commercial interests may be the strongest driver of what goes into formula milk, warn child health experts in this week's BMJ. Professors Berthold Koletzko and Raanan Shamir describe a meeting in Bonn, Germany in November 2005 to revise the standard on infant formula. The meeting involved government delegations, non-governmental organizations, and other groups with commercial interests in infant formula.

Infant formula must meet very high quality standards. The Codex Alimentarius Commission, part of both the Food and Agriculture Organisation of the United Nations and the World Health Organisation, develops standards and guidelines on food to protect consumers' health and to ensure fair trade practices globally.

Three scientific reviews all agree that the safe level of infant formula protein should be based on a recognised nitrogen conversion factor. In Bonn, however, the International Dairy Federation demanded that the proportion of protein in formula derived from cows' milk should be based on a larger nitrogen conversion factor.

Even though no scientific arguments were put forward to justify the federation's request, and it would falsely indicate that cow's milk protein is superior to human milk protein, it got support from several member states with strong dairy industries. While the industry argues that using the lower nitrogen conversion factor would lead to a loss of some €80m (Ł55m; $96m) for the dairy industry in Europe alone, this is clearly not the case if the appropriate factor is applied to infant feeding products.

Another controversial issue was the approach to setting maximum values for nutrients. The scientific expert report recommended that the contents of water soluble vitamins in infant formulas should not exceed five times the minimum level unless there are data to justify other decisions.

But, contrary to this strong scientific advice, some member states requested that the maximum values should be established only for levels of nutrients with documented adverse effects in infants, while in all other cases only interim upper values should be established which would not be binding for manufacturers.

Moreover, the US delegation requested that both maximum values and guidance values should not be lower than values used for formulas already on the market, even if such levels have not been subjected to systematic evaluation of their biological effects and safety. The worldwide medical community might question the basis of these decisions and might rise to reject such commercial pressures, suggest the authors.

Doctors should choose and recommend only those infant formulas with compositions based on current scientific knowledge and on the nutritional requirements of infants, they conclude.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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