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      Marketing and child feeding

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          Abstract

          Objective

          To carry out a narrative review on the use of marketing strategies in child nutrition, as well as potential implications for health professionals and children.

          Data source

          Searches were carried out on the PubMed, SciELO, and Google platforms, using the terms “child nutrition” or “industrialized baby food” or “infant formula” or “breast milk” or “breastfeeding” and “marketing”, with original articles, review articles, institutional reports, institutional position documents and websites considered relevant to the topic being analyzed.

          Data synthesis

          Children's food marketing started with the industrialization of food and the resulting actions aimed at increasing sales and meeting commercial interests. Since its inception to the present, infant formulas have been the most widely used products, which has impacted breastfeeding practices. International and national institutions, that care for children's health, are searching for strategies to limit the abusive marketing of industrialized children's foods. Marketing strategies interfere with medical knowledge and actions, potentially influencing the guidance provided by pediatricians to families, and finally, compromising healthy eating practices at a critical period in life, with possible long-term effects.

          Conclusions

          Health professionals, especially pediatricians, must provide the best care for children and families, and need to maintain the search for quality scientific information, not influenced by conflicts of interest. Updated and critical knowledge on the part of healthcare professionals can curb marketing strategies that aim to influence their actions.

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          Most cited references49

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          Ultra-processed foods: what they are and how to identify them

          The present commentary contains a clear and simple guide designed to identify ultra-processed foods. It responds to the growing interest in ultra-processed foods among policy makers, academic researchers, health professionals, journalists and consumers concerned to devise policies, investigate dietary patterns, advise people, prepare media coverage, and when buying food and checking labels in shops or at home. Ultra-processed foods are defined within the NOVA classification system, which groups foods according to the extent and purpose of industrial processing. Processes enabling the manufacture of ultra-processed foods include the fractioning of whole foods into substances, chemical modifications of these substances, assembly of unmodified and modified food substances, frequent use of cosmetic additives and sophisticated packaging. Processes and ingredients used to manufacture ultra-processed foods are designed to create highly profitable (low-cost ingredients, long shelf-life, emphatic branding), convenient (ready-to-consume), hyper-palatable products liable to displace all other NOVA food groups, notably unprocessed or minimally processed foods. A practical way to identify an ultra-processed product is to check to see if its list of ingredients contains at least one item characteristic of the NOVA ultra-processed food group, which is to say, either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).
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            The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.

            Given evident multiple threats to food systems and supplies, food security, human health and welfare, the living and physical world and the biosphere, the years 2016-2025 are now designated by the UN as the Decade of Nutrition, in support of the UN Sustainable Development Goals. For these initiatives to succeed, it is necessary to know which foods contribute to health and well-being, and which are unhealthy. The present commentary outlines the NOVA system of food classification based on the nature, extent and purpose of food processing. Evidence that NOVA effectively addresses the quality of diets and their impact on all forms of malnutrition, and also the sustainability of food systems, has now accumulated in a number of countries, as shown here. A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption. Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries. The evidence so far shows that displacement of minimally processed foods and freshly prepared dishes and meals by ultra-processed products is associated with unhealthy dietary nutrient profiles and several diet-related non-communicable diseases. Ultra-processed products are also troublesome from social, cultural, economic, political and environmental points of view. We conclude that the ever-increasing production and consumption of these products is a world crisis, to be confronted, checked and reversed as part of the work of the UN Sustainable Development Goals and its Decade of Nutrition.
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              Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review

              Objectives The objective of this review is to explore interactions between physicians and the pharmaceutical industry including sales representatives and their impact on physicians’ attitude and prescribing habits. Data sources PubMed, Embase, Cochrane Library and Google scholar electronic databases were searched from 1992 to August 2016 using free-text words and medical subject headings relevant to the topic. Study selection Studies included cross-sectional studies, cohort studies, randomised trials and survey designs. Studies with narrative reviews, case reports, opinion polls and letters to the editor were excluded from data synthesis. Data extraction Two reviewers independently extracted the data. Data on study design, study year, country, participant characteristics, setting and number of participants were collected. Data synthesis Pharmaceutical industry and pharmaceutical sales representative (PSR) interactions influence physicians’ attitudes and their prescribing behaviour and increase the number of formulary addition requests for the company’s drug. Conclusion Physician–pharmaceutical industry and its sales representative’s interactions and acceptance of gifts from the company’s PSRs have been found to affect physicians’ prescribing behaviour and are likely to contribute to irrational prescribing of the company’s drug. Therefore, intervention in the form of policy implementation and education about the implications of these interactions is needed.
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                Author and article information

                Contributors
                Journal
                J Pediatr (Rio J)
                J Pediatr (Rio J)
                Jornal de Pediatria
                Elsevier
                0021-7557
                1678-4782
                31 October 2023
                Mar-Apr 2024
                31 October 2023
                : 100
                : Suppl 1
                : S57-S64
                Affiliations
                [a ]Universidade Federal de Pernambuco (UFPE), Centro de Ciências Médicas, Área Acadêmica de Pediatria, Recife, PE, Brazil
                [b ]Universidade Federal de Pernambuco (UFPE), Centro de Ciências Médicas, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
                [c ]Universidade Federal de Pernambuco (UFPE), Hospital das Clínicas, Serviço de Gastroenterologia Pediátrica, Recife, PE, Brazil
                Author notes
                [* ]Corresponding author. katia.brandt@ 123456ufpe.br
                Article
                S0021-7557(23)00131-6
                10.1016/j.jped.2023.09.013
                10960183
                37918811
                536e5d9c-bbdd-4678-9f29-01e98264712e
                © 2023 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 September 2023
                : 18 September 2023
                Categories
                Review Article

                nutrition,childhood,marketing,breastfeeding,infant formula
                nutrition, childhood, marketing, breastfeeding, infant formula

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