A The Need for Legislation on the Nutritional Composition of Infant Cereals: A Review of the Spanish Market.
A Call for Clearer Labels and Healthier Formulations
Keywords:
Added Sugars, Complementary Feeding, Infant Cereals, Labelling, Nutritional Composition.Abstract
World Health Organization recommends complementary feeding alongside breastfeeding starting at six months. Infant cereals are among the first complementary foods introduced into children’s diets, playing a vital role in their transition from exclusive breastfeeding to diversified feeding. Although labelling is a critical tool for enabling parents to make informed choices, it often lacks clarity and presents vague or misleading information, especially for products targeted to children. Parents are increasingly vigilant to added sugars, refined flours, and processed ingredients, demanding healthier options and greater transparency. This growing concern underscores the gap between marketing claims and actual nutritional value. This study examined labelling of 56 infant cereal brands available in the Spanish market, categorizing them into rice-, corn-, rice/corn- and multigrain-based products. The analysis focused on regulatory compliance and quantity of sugar present. The research revealed that 75% of the analysed cereal brands contained sugar either through direct addition or via dextrinization (starch hydrolysis). Alarmingly, 35.7% of the selected brands exhibited high free sugar content, with some brands reaching up to 35% total sugar. Multigrain cereals exhibited superior nutritional profiles, offering significantly higher levels of protein and fibre compared to rice- or rice/corn-based brands. Notably, the study highlights that current EU regulations permit total sugar contents ranging from 24.5% to 61%, depending on the cereal's energy content. This may pose a risk to infant health. In light of these findings, we advocate for an urgent update of European legislation concerning the nutritional composition of foods for children under 3 years of age.
References
- Adhikari, S., Schop, M., de Boer, I. J. M., & Huppertz, T. (2022). Protein Quality in Perspective: A Review of Protein Quality Metrics and Their Applications, Nutrients, 14(5), 947. https://doi.org/10.3390/nu14050947.
- Agencia Española de Seguridad Alimentaria y Nutrición (AESAN). Información alimentaria facilitada al consumidor. https://www.aesan.gob.es/AECOSAN/web/seguridad_alimentaria/detalle/etiquetado_informacion_alimentaria.htm
- Ahnen, R. T., Jonnalagadda, S. S., & Slavin J. L. (2019). Role of plant protein in nutrition, wellness, and health. Nutrition Reviews, 77(11), 735-747. https://doi.org/10.1093/nutrit/nuz028.
- BEDCA: Base de Datos Española de Composición de Alimentos. (2006). Retrieved from: http://www.bedca.net/. Accessed May 3, 2025.
- Beltrá, M., Soares-Micoanski, K., Navarrete-Muñoz, E.-M., & Ropero, A. B. (2020). Nutrient Composition of Foods Marketed to Children or Adolescents Sold in the Spanish Market: Are They Any Better? Int. J. Environ. Res. Public Health, 17, 7699. https://doi.org/10.3390/ijerph17207699
- Bischoff-Ferrari, H. A. (2011). Vitamin D: Role in pregnancy and early childhood. Annals of Nutrition & Metabolism, 59(1), 17–21. https://doi.org/10.1159/000332069.
- Campbell, W. W. (2019). Animal-based and plant-based protein-rich foods and cardiovascular -health: a complex conundrum. American Journal of Clinical Nutrition, 110(1), 8-9. https://doi.org/10.1093/ajcn/nqz074.
- Commission Directive 2006/125/EC of 5 December 2006 on processed cereal-based foods and baby foods for infants and young children. Official Journal of the European Union. https://eur-lex.europa.eu/eli/dir/2006/125/oj#:~:text=http%3A//data.europa.eu/eli/dir/2006/125/oj
- Committee on Nutrition. (2017). Complementary feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of Pediatric Gastroenterology and Nutrition, 64, 64:119–132. doi: 10.1097/MPG.0000000000001454.
- Correa, T., Fierro, C., Reyes, M., Dillman Carpentier, F. R., Taillie, L. S., & Corvalan, C. (2019). Responses to the Chilean law of food labeling and advertising: exploring knowledge, perceptions and behaviors of mothers of young children. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 21. https://doi.org/10.1186/s12966-019-0781-x.
- Dang, A. (2023). Real-World Evidence: A Primer. Pharmaceutical Medicine, 37(1), 25-36. https://doi.org/10.1007/s40290-022-00456-6.
- Davis, C., Rivera, M., & Burns, B. (2020). Protein quality and its importance in child development. Journal of Nutritional Biochemistry, 38, 45-52. https://doi.org/10.1016/j.jnutbio.2016.01.006.
- Debras, C., Chazelas, E., Srour, B., Kesse-Guyot, E., Julia, C., Zelek, L., Agaësse, C., Druesne-Pecollo, N., Galan, P., Hercberg, S., Latino-Martel, P., Deschasaux, M., & Touvier, M. (2020). Total and added sugar intakes, sugar types, and cancer risk: results from the prospective NutriNet-Santé cohort. American Journal of Clinical Nutrition, 112(5), 1267-1279. https://doi.org/10.1093/ajcn/nqaa246.
- Delley, M., & Brunner, T. A. (2019) Breakfast eating patterns and drivers of a healthy breakfast composition. Appetite, 137, 90-98. https://doi.org/10.1016/j.appet.2019.02.006.
- Detzel, P., & Klassen-Wigger, P. (2020). Market-Driven Food Fortification to Address Dietary Needs. World Review of Nutrition and Dietetics, 121, 81-88. https://doi.org/10.1159/000507522.
- DiMaggio D.M., Cox A., Porto A.F. AAP Publications. Updates in infant nutrition. Pediatr. Rev. 2017;38:449–462. https://doi.org/10.1542/pir.2016-0239
- DiNicolantonio, J. J., & Lucan, S. C. (2014). The wrong white crystals: Not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart, 1, e000167. https://doi.org/10.1136/openhrt-2014-000167.
- Duran, A.C.; Ricardo, C.Z.; Mais, L.A.; Martins, A.P.B.; Taillie, L.S. Conflicting Messages on Food and Beverage Packages:Front-of-Package Nutritional Labeling, Health and Nutrition Claims in Brazil. Nutrients 2019, 11, 2967. https://www.mdpi.com/2072-6643/11/12/2967
- European court of auditors (ECA). Food Labelling in the EU: Consumers can get lost in the maze of labels. 2024. https://www.eca.europa.eu/ECAPublications/SR-2024-23/SR-2024-23_ES.pdf
Fewtrell M., Bronsky J., Campoy C., Domellöf M., Embleton N., Fidler Mis N., Hojsak I., Hulst J.M., Indrio F., Lapillonne A., & Molgaard, C. (2017). Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 64(1), 119–132. https://doi.org/10.1097/MPG.0000000000001454
- Fretes, G., Sepúlveda, A., Corvalán, C., & Cash, S.B. (2021). Children's Perceptions about Environmental Sustainability, Food, and Nutrition in Chile: A Qualitative Study. International Journal of Environmental Research and Public Health, 18(18), 9679. https://doi.org/10.3390/ijerph18189679.
- Grammatikaki, E., Wollgast,J., Caldeira, S.; (2019) Feeding infants and young children. A compilation of national food-based dietary guidelines and specific products available in the EU market. . https://www.researchgate.net/publication/331674431_Feeding_infants_and_young_children_A_compilation_of_national_food-based_dietary_guidelines_and_specific_products_available_in_the_EU_market#fullTextFileContent [accessed Oct 26 2025].
- Haug, A., Meier, J., & Palomino, R. (2019). Protein supplementation in cereals: Effects on child growth. Journal of Pediatric Gastroenterology, 58(1), 35-40. https://doi.org/10.1097/MPG.0000000000002541.
- Huang, Y., Chen, Z., Chen, B., Li, J., Yuan, X., Li, J., Wang, W., Dai, T., Chen, H., Wang, Y., Wang, R., Wang, P., Guo, J., Dong, Q., Liu, C., Wei, Q., Cao, D., & Liu, L. (2023). Dietary sugar consumption and health: umbrella review. British Medical Journal, 381, e071609. https://doi.org/10.1136/bmj-2022-071609.
- Klerks, M., Bernal, M. J., Roman, S., Bodenstab, S., Gil, A., & Sanchez-Siles, L. M. (2019). Infant Cereals: Current Status, Challenges, and Future Opportunities for Whole Grains. Nutrients, 11(2), 473. https://doi.org/10.3390/nu11020473
- Leite, F.H.M.; Mais, L.A.; Ricardo, C.Z.; Andrade, G.C.; Guimarães, J.S.; Claro, R.M.; Duran, A.C.D.F.L.; Martins, A.P.B. Nutritional quality of foods and non-alcoholic beverages advertised on Brazilian free-to-air television: A cross-sectional study. BMC Public Health 2020, 20, 385. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08527-6
- Micha, R., Peñalvo, J., Cudhea, F., & Rehm, C. (2017). Global diet patterns and non-communicable disease risk. The Lancet, 390(10145), 805-819. https://doi.org/10.1016/S0140-6736(17)31388-8.
- Moreno-Aznar, L. A., Vidal Carou, M. D. C., López Sobaler, A. M., Varela-Moreiras, G., & Moreno Villares, J. M. (2020). Papel del desayuno y su calidad en la salud de los niños y adolescentes en España [Role of breakfast and its quality in the health of children and adolescents in Spain]. Nutrición Hospitalaria, 38(2), 396-409. https://doi.org/10.20960/nh.03398.
- Motuhifonua, S. K., Lin, L., Alsweiler, J., Crawford, T. J., & Crowther, C. A. (2023). Antenatal dietary supplementation with myo-inositol for preventing gestational diabetes. Cochrane Database Systematic Reviews, 2(2), CD011507. https://doi.org/10.1002/14651858.CD011507.pub3.
- Nicklas, T. A., O'Neil, C. E., & Fulgoni, V. L., 3rd (2020). Nutrient intake, introduction of baby cereals and other complementary foods in the diets of infants and toddlers from birth to 23 months of age. AIMS public health, 7(1), 123–147. https://doi.org/10.3934/publichealth.2020012
- Niinikoski, H., & Ruottinen, S. (2012). Is carbohydrate intake in the first years of life related to future risk of NCDs?. Nutrition, metabolism, and cardiovascular diseases : NMCD, 22(10), 770–774. https://doi.org/10.1016/j.numecd.2012.05.002
- Pan American Health Organization. (PAHO) Nutrient Profile Model. 2016. Available online: https://iris.paho.org/bitstream/handle/10665.2/18621/9789275118733_eng.pdf (accessed on 22 February 2023).
Potvin Kent, M., Rudnicki, E. & Usher, C. (2017). Less healthy breakfast cereals are promoted more frequently in large supermarket chains in Canada. BMC Public Health, 17, 877. https://doi.org/10.1186/s12889-017-4886-3.
- Quintaes, K., Barberá, R., & Cilla, A. (2017). Iron bioavailability in iron-fortified cereal foods: The contribution of in vitro studies. Critical Reviews in Food Science and Nutrition, 57(10), 2028-2041. https://doi.org/10.1080/10408398.2013.866543.
- Regulation (EU) No 609/2013 of the European Parliament and of the Council of 12 June 2013 on food intended for infants and young children, food for special medical purposes, and total diet replacement for weight control and repealing Council Directive 92/52/EEC, Commission Directives 96/8/EC, 1999/21/EC, 2006/125/EC and 2006/141/EC, Directive 2009/39/EC of the European Parliament and of the Council and Commission Regulations (EC) No 41/2009 and (EC) No 953/2009 Text with EEA relevance. https://eur-lex.europa.eu/eli/reg/2013/609/oj/eng/. Accessed May 5, 2025).
- Regulation (EU) No 1169/2011 of The European Parliament and of The Council of 25 October 2011 on the provision of food information to consumers, amending Regulations (EC) No 1924/2006 and (EC) No 1925/2006 of the European Parliament and of the Council, and repealing Commission Directive 87/250/EEC, Council Directive 90/496/EEC, Commission Directive 1999/10/EC, Directive 2000/13/EC of the European Parliament and of the Council, Commission Directives 2002/67/EC and 2008/5/EC and Commission Regulation (EC) No 608/2004. http://data.europa.eu/eli/reg/2011/1169/oj
- Robert D. Baker, Frank R. Greer, The Committee on Nutrition; Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics November 2010; 126 (5): 1040–1050. 10.1542/peds.2010-2576.
- Ropero, A.B.; Borrás, F.; Rodríguez, M.; Beltrá, M. Nutritional Description of Organic and Conventional Food Products in Spain: The BADALI Project. Nutrients 2023,
, 1876. https://doi.org/10.3390/nu15081876
- Sanchez-Siles, L. M., Bernal, M. J., Gil, D., Bodenstab, S., Haro-Vicente, J. F., Klerks, M., Plaza-Diaz, J., & Gil, Á. (2020). Are Sugar-Reduced and Whole Grain Infant Cereals Sensorially Accepted at Weaning? A Randomized Controlled Cross-Over Trial. Nutrients, 12(6), 1883. https://doi.org/10.3390/nu12061883
- Scientific Advisory Committee on Nutrition Feeding (SCAN) in the First Year of Life.;2018.https://www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report.
- Signes-Pastor, A. J., Carey, M., & Meharg, A. A. (2016). Inorganic arsenic in rice-based products for infants and young children. Food Chemistry, 191, 128-134. https://doi.org/10.1016/j.foodchem.2014.11.078.
- United States Department of Agriculture (USDA) Timing of Introduction of Complementary Foods and Beverage and Developmental Milestones: A Systematic Review. https://nesr.usda.gov/sites/default/files/2019-04/Timing%20of%20CFB-Developmental%20Milestones-NE..._0.pdf.
- Varea Calderón, V.; Dalmau Serra, J.; Lama Más, R.; Leis Trabazo, R. Papel de los cereales en la alimentación infantil. Acta Pediátr. Esp. 2013 , 71 , 91–98. https://www.actapediatrica.com/index.php/secciones/revision/download/1109_cc01ed3d844d20bb0a7fb2c91d18ba2a.
- Vitoria I, Correcher P. Papel de las recomendaciones nutricionales de ESPGHAN sobre azúcares libres en la reformulación de los cereales para lactantes. Libro de trabajos SEGHNP. 2020:149---50 [consultado 28 Oct 2020] Disponible en https://www.seghnp.org/documentos/libro-de-trabajos2020-de-seghnp.
- Willett, W.; Rockström, J.; Loken, B.; Springmann, M.; Lang, T.; Vermeulen, S.; Garnett, T.; Tilman, D.; DeClerck, F.; Wood, A. Food in the Anthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 2019, 393, 447–492. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31788-4/fulltext
- Wise, S. A., & Phillips, M. M. (2019). Evolution of reference materials for the determination of organic nutrients in food and dietary supplements-a critical review. Analytical and Bioanalytical Chemistry, 411(1), 97-127. https://doi.org/10.1007/s00216-018-1473-0.
- World Health organization (WHO). Exclusive breastfeeding for optimal growth, development and health of infants. 9 August 2023. https://www.who.int/tools/elena/interventions/exclusive-breastfeeding
- World Health Organization (WHO). (2020). Guideline: Sugars intake for adults and children. https://www.who.int/publications/i/item/9789241549028/. Accessed May 2, 2025. Healthy diet. https://www.who.int/news-room/fact-sheets/detail/healthy-diet/. Accessed May 3, 2025.
- World Health Organization. Sustainable Healthy Diets: Guiding Principles; Food & Agriculture Organization: Roma, Italy, 2019. https://books.google.com/books?hl=es&lr=&id=pH-4DwAAQBAJ&oi=fnd&pg=PP2&ots=Jrq8lwezhk&sig=PMPXXt4GE1-7woKtpoP81Jry2WQ
- World Health organization. Food and Agriculture Organization of the United Nations. (FAO) Codex alimentarius food labelling 1º Editión. Roma 2007. https://openknowledge.fao.org/server/api/core/bitstreams/341fd763-bc1c-49c7-b6bf-424733f37b04/content
- World Health Organization. UNICEF . Global Strategy for Infant and Young Child Feeding. WHO; Geneva, Switzerland: 2002. https://www.who.int/publications/i/item/9241562218
- Zalewski, B. M., Weiss, G. A., Campoy, C., Decsi, T., Di Profio, E., Mestdagh, R., Rakhshandehroo, M., Szajewska, H., Theis, S., Vaughan, E. E., Verduci, E., & Chang, C. Y. (2025). ILSI Europe Systematic Review: The Impact of Digestible and Nondigestible Carbohydrate Consumption for Toddlers (1-4 Years) in Relation to Health Outcomes. Nutrition Reviews, 212. https://doi.org/10.1093/nutrit/nuae212.
?