Cerelac controversy: How harmful is 'added sugar' in baby foods for children?

According to the report by Swiss investigative organisation Public Eye, the team found 'added sugar' in the form of sucrose or honey in samples of Nido as well, which is a follow-up milk formula brand for infants aged one and above. But what is horrific and beyond any "justification" is that the added sugar was only found in Nestle’s baby food products sold in less affluent nations like Asia, Africa and Latin America and not in its primary markets like Europe and the USA.

This report comes just a couple of days after Bournvita, another beverage that most children in India grow up drinking, the ministry of commerce asked e-commerce websites to remove this brand from the ‘health drink’ category. It may have to do with a technical issue involving the FSS Act 2006, Bournvita too has come under a cloud after “complaints” alleging that Bournvita markets itself as a health drink which improves ‘children’s growth and development' even when it contains a high amount of sugar, said media reports.

So, what’s the hullabaloo over baby food manufacturing companies mixing dollops of the offensive “added sugar” in infant formula, cereals and beverages? And how is it harmful to children?

First of all, what is ‘added sugar’?

The World Health Organization (WHO) and Health Canada define 'added sugar' as any type of dietary sugar that is added in processing or preparation of foods.

Added sugars are sugars and syrups that are added to foods during processing or preparation. They can be natural sugars, like honey, or artificial sweeteners, like high-fructose corn syrup. As it turns out, yogurt, baby foods and snacks, fruit drinks, desserts and sweet bakery products are the most common sources of added sugars in the diets of infants and toddlers.

In fact, infant formula milks ostensibly contain added sugars such as corn syrup which are added during production and are not found in breast milk.

What do WHO and experts say about added sugars ?

Infants have a natural affinity for sweet foods overall. But doctors and experts advise that added sugar should not be given to infants (mother’s milk is best) at all, while little or no added sugar is advised for children 12 to 24 months old. 

Meanwhile, WHO has repeatedly called for a ban on added sugar in baby food and warned manufacturing companies against 'misleading' health claims on labels. After analysis of thousands of baby products in Europe, in 2015, WHO had warned that added sugar can give the child a "sweet tooth" and lead to baby teeth to rot and increase the risk of obesity and related diseases. They wanted a ban on added sugars and sweeteners in foods for children under three years of age.

Meanwhile, the Phillipines government is also seriously considering regulations that will ban the use of added sugar in food for children below the age of three.

What is the affect of added sugar intake at an early age on a child?

Too much sugar in childhood may lead to unhealthy cravings as kids grow older. In excess, sugar can lead to obesity, which puts a child at risk for developing high blood pressure, elevated cholesterol levels and type 2 diabetes (where the body’s response to insulin is not regulated). There is also a risk of obesity.

One study found that consumption of sugar-sweetened beverages in the first year of life was associated with a 13 per cent increase in the risk of being overweight at 8 years of age.

In India, obesity is a matter of growing concern, as 12.5 million children (7.3 million boys and 5.2 million girls), aged between five and 19, were grossly overweight in 2022, up from 0.4 million in 1990, as per a recent Lancet report.

What are the other adverse effects of added sugar?

From birth to 24 months, a child consuming foods and beverages high in added sugars is collecting a lot of calories – referred to as “empty calories” – but not a lot of nutrients. Since they eat relatively small amounts of food at this stage, they may have little room left for the nutritious options that growing bodies need, such as fruits, vegetables, whole grains, low-fat dairy and lean protein.

Children also develop a strong preference for a sweet taste and early introduction of added sugars in the diet of infants and toddlers may further promote a sweet taste preference.

The diet from birth to 24 months also shapes long-term food preferences, Setting healthy diet patterns early in life can help children maintain a healthy weight and avoid chronic diseases.

“Children get used to the sweet taste and start looking for more sugary foods, starting a negative cycle that increases the risk of nutrition-based disorders in adult life. These include obesity and other chronic non-communicable diseases, such as diabetes or high blood pressure,” said a WHO spokesperson, reacting to the Cerelac controversy.

Can added sugars cause tooth decay?

Children who are fed diets high in added sugars are also more likely than children with lower sugar intakes to get tooth decay and cavities. The European Journal of Paediatric Dentistry said that studies have confirmed the direct correlation between intake of dietary sugars and carious disease throughout the course of life.

What do Indian paediatricians recommend?

In India, pediatricians strictly recommend not giving sugar till the infant turns two years old. Meanwhile, The Indian Council of Medical Research (ICMR) recommends not more than 5 per cent to 7 per cent of total energy coming from free sugar/added sugars for kids above 2 years. 

Experts said that breast milk is the recommended source of nutrition for infants, especially during the first six months of life. Although it is sweet and high in energy, the sugar is mainly lactose and the content is specific to the needs of the growing infant.

Pediatricians suggest that parents pay attention to nutrition labels. While choosing a cereal or snack pick the box with the fewest grams of added sugar. Choose fruits and vegetables over packaged products. 

Labels include the amount of “Total Sugars” and, below that, the amount of “Added Sugars”. Consumers need not get confused as added sugars go by many different names, such as high-fructose corn syrup, fruit juice concentrates, cane sugar, corn sweetener, lactose, glucose, sucrose and maple syrup. Check the ingredient list.

What are the healthy food options for children? 

If children are presented healthy food choices when they are young, they'll be more likely to eat healthy foods as they grow older. Here are a few low-sugar snack options children may like:

• Apple slices with peanut butter
• Oranges
• Cheese and whole grain crackers
• Popcorn
• Hummus and whole grain pita chips

• Sugary foods can be offered strategically. Sprinkle granola on top of low-fat plain yogurt or top berries with a half scoop of ice cream. 

Sugar should preferably be consumed as part of a main meal and in a natural form (human milk, cow or sheep milk, unsweetened dairy products, fresh fruits) rather than as Sugar Sweetened Beverages (SSBs), smoothies, fruit juices and sweetened milk products. 

What needs to be done?

Many concerned authorities are demanding that manufacturers disclose added sugar quantities in a clear and prominent fashion on their packaging. This kind of disclosures and clear labelling can help consumers to make informed choices about the food products they are purchasing.

Is the baby food industry, which recorded a revenue of US$75.59bn in 2024 listening?