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ISDI acknowledges the Breastmilk Substitutes ‘Call to Action’ – the Road to Compliance with the International Code of Marketing of Breast-milk Substitutes (WHO Code), issued by the World Health Organization, UNICEF and a group of Civil Society Organisations (CSOs) on 25 June 2020, and welcomes the collective dialogue to achieve our common goal of improving the nutritional status of infants and young children‎.

As the leading international expert association on special dietary foods, ISDI welcomes the continued dialogue and the momentum created by the Call to Action’s 10-year process and will continue to play its role as a platform of discussion for the industry.

In responding to the Call to Action, companies have confirmed that the infant and young child nutrition industry supports the aims and principles of the WHO Code and public health goals that protect and promote breastfeeding. ISDI and its members, moreover, are committed to full compliance with all laws, regulations and policies as implemented by national governments.

‎Every infant has the right to high quality nutrition. There is no doubt that breastfeeding is the optimal way to ensure the healthy growth and development of infants during the first months of life. When breastfeeding is not possible, the only recognised and proven alternatives are scientifically developed and clinically demonstrated breastmilk substitutes (BMS).

However, too many infants around the world, whether they are breastfed, formula fed or mixed-fed, are afflicted by malnutrition and its consequences. The infant and young child nutrition industry remains committed to providing high quality, safe and age-appropriate nutrition for pregnant mothers, infants and young children, and to offering education on healthy nutrition to accelerate progress towards achieving the UN Sustainable Development Goals of ‘Zero Hunger’ (SDG2) and good health and well-being (SDG3).

Infant feeding choices and nutrition are complex and multifaceted, whereby environmental, socioeconomic and cultural factors should be taken into account. The WHO and UNICEF identify seven targets for improving breastfeeding rates. These targets include measures to enhance funding, workplace policies, family leave, counselling and community networks.

The Call to Action is an important step in recognising the need for a multi-stakeholder approach towards this complex issue. All sectors of society – i.e. governments, policy-makers, CSOs, academia, healthcare professionals, industry, parents and the general public – are required to create an all-inclusive, supportive ecosystem to encourage breastfeeding and to improve nutritional outcomes for mothers, infants and young children. We need to continue to work on this important issue together and we look forward to building upon the progress made so far through continued dialogue and fruitful partnerships (SDG17).

We remain committed to working constructively with all relevant stakeholders ‎and engaging in locally acceptable, effective, ethical and sustainable initiatives to address ‎nutrition and development challenges.

Diabetes is a growing global health concern, with the prevalence of the disease among adults rising from 4.7% to 9.1% over the past 30 years. In 2019, this represented an estimated 463 million adults around the world (expected to rise to 578 million by 2030) and caused 4.2 million deaths, costing over $760 billion in health expenditure.

For hospitalised patients with diabetes, poor glycaemic control is common. This increases the risk of perioperative infection, extends their length of stay and carries a greater risk of mortality. Addressing poor glucose control, thus, improves patient outcomes and cuts the cost of care.

The American Diabetes Association has defined two key goals for nutrition therapy of hospitalised patients: to optimise glycaemic control and provide adequate nutrients to meet metabolic demands.

Diabetes-specific formulas (DSFs) are a category of foods for special medical purposes designed to meet these objectives by not only supporting the metabolic nutritional requirements of a standard formula, but also minimising glycaemic response. DSFs are also endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN) for the nutritional support of people with obesity and diabetes.

Based on the evidence of clinical, health and economic outcomes, DSFs improve patient outcomes and cut the cost of care by: 

• Improving glucose levels and reducing glycaemic variability
• Reducing the risk of hypoglycaemia, and blunting the hyperglycaemia of stress-related metabolism
• Reducing insulin requirements
• Reducing length of stay, which leads to a reduction in total cost

Therefore, ISDI endorses the use of DSFs as a safe, efficacious and cost-effective strategy to support the management of hospitalised patients with, or at risk of, poor glucose control.

The composition of infant formulas is strictly regulated and rigorously tested by official control bodies. Occasionally, competent authorities find deviations between test results vis-à-vis regulatory parameters. One reason for the discrepancies is the use of different analytical methods.

To ensure products meet the highest standards, the global infant formula industry works to ensure a thorough understanding of the capability of an analytical method (i.e. the ability of a method to produce test results within the regulatory limits) as an additional key parameter when establishing compositional criteria for nutrients in infant formulas.

We acknowledge that all analytical test methods have some uncertainty. The key factor is understanding method variability in the context of the overall variability, which also includes variation in raw materials/ingredients and the manufacturing process. The overall variability must fit within the regulatory limits.

Recently, a cross industry group of experts performed an innovative study using existing performance data to identify suitability criteria for compliance testing. The capability of an analytical method was defined and calculated for state-of–the-art internationally recognised reference methods to establish the percentage of deviations from regulatory requirements. Compositional requirements for infant formulas (including foods for special medical purposes intended for infants) in different countries were also reviewed. 

The findings showed that the analytical method capability for vitamins A, B₁₂, D and folic acid are of concern in relation to the regulatory requirements in countries such as China, EU member states, Pakistan, Russia, Singapore, South Africa, and Thailand. In addition, a deviation was observed regarding vitamin D in Europe for products with a manufacturing target at the midpoint of regulations. In this case the probability of obtaining an analytical result outside the regulatory requirements due to analytical variation of the method alone can be as high as 19%, which can cause legal uncertainties.

The findings were recently published in the scientific journal Food Control. The paper was co-authored by a number of SPIFAN stakeholders and can be accessed here.

On this World Patient Safety Day, we celebrate the health workers who have faced huge challenges and great risk in keeping patients—and themselves—safe during this global public health crisis.  We also call out the important role of appropriate nutrition interventions across the continuum of care in improving patient safety and outcomes.

The current COVID-19 global public health crisis has highlighted even more the vulnerability of patients and the critical role that healthcare workers play in safeguarding patients’ health, especially as our healthcare systems and health workers are challenged to safely treat a large influx of patients.

During this pandemic, foods for special dietary use (FSDU) have been a critical necessity to meet the nutritional requirements of those in need and, for severe COVID-19 patients, foods for special medical purposes (FSMP) can be a lifeline by providing the essential nutrients they need to recover and thrive.

Data show that nutrition-focused interventions are a low-risk and cost-effective strategy that can significantly improve outcomes for patients. The provision of nutrition, particularly early enteral nutrition, administered via a feeding tube in critically ill and surgical patients, has been recognised as an effective measure for patient safety[1].

In addition to treatment, nutrition screening is also an important tool to enable healthcare professionals to identify patients who are at-risk of disease-related malnutrition and who would benefit from medically-recommended nutrition interventions.

Furthermore, comprehensive nutrition assessments and Quality Improvement Programmes (QIPs), which systematically develop, test and evaluate changes to clinical practice, should provide the basis for individualised nutrition care and management plans.