Commercial Complementary Food in Germany: A 2020 Market Survey

Round 1

Reviewer 1 Report

Dear Authors, 

I am sending you below the important points that need to be improved in the publication. The paper presented to me for review - Commercial complementary food in Germany: a 2020 market 2 survey - is very interesting from the point of view of infant nutrition, ready-to-eat food.

The study is important because parents are increasingly using ready-made meals, so-called 'meals in a jar', rather than home-made food. And I can see from your research that jarred food is not ideal for this age group.

Introduction

On line 43, please explain the difference between 4-6 months and 6 months. At the same time, please elaborate on what are the standards adopted in Germany.

The purpose of the study has been clearly defined.

The material and methods of the study are described in great detail.

Results:

The results presented in Table 2 are very unclear. I suggest that the table be adjusted according to editorial requirements, or split into two tables for infants and toddlers. At the same time, please describe what results are in brackets, as this is not described properly.

Table 4. - is not readable, I suggest presenting the results in a more readable way - e.g. in a graph.

Discussion

Please describe, based on other research, how often parents use prepared foods compared to home-cooked meals. How many children eat jarred versus store-bought ready-made meals - both in Germany and in other European countries. It is also worth referring to the amount of complementary food consumed in this youngest group and the fact that children do not eat everything their parents offer them. 

Conclusions

In line 43, please describe in more detail the claims made by Hutchinson et al. In your conclusions, please emphasise which inappropriate ingredients were found in the foods tested, whether more were compliant or non-compliant.

Best regards

Reviewer

Author Response

Reviewer 1

I am sending you below the important points that need to be improved in the publication. The paper presented to me for review - Commercial complementary food in Germany: a 2020 market 2 survey - is very interesting from the point of view of infant nutrition, ready-to-eat food.

The study is important because parents are increasingly using ready-made meals, so-called 'meals in a jar', rather than home-made food. And I can see from your research that jarred food is not ideal for this age group.

Thank you for this commment.

Introduction

On line 43, please explain the difference between 4-6 months and 6 months. At the same time, please elaborate on what are the standards adopted in Germany.

Thank you for this suggestions. We have changed the introduction accordingly:

“In the first months after birth, breast milk is regarded as the normative standard for infant feeding [11]. In Germany and Europe, exclusive breastfeeding is recommended for 4-6 months [7,9], whereas internationally exclusive breastfeeding is recommended for approximately six months [10,11].“

The purpose of the study has been clearly defined.

The material and methods of the study are described in great detail.

Thank you again.

Results:

The results presented in Table 2 are very unclear. I suggest that the table be adjusted according to editorial requirements, or split into two tables for infants and toddlers. At the same time, please describe what results are in brackets, as this is not described properly.

We agree, that the table presents a huge amount of data, but we do not feel, that a separation into two similar tables would help the reader substantially. Please note, that in the footnote the meaning of the values has been explained. We now give this information in the title, so that it is not overlooked.

Table 4. - is not readable, I suggest presenting the results in a more readable way - e.g. in a graph.

As suggested, we changed table 4 into figure 2.

Discussion

Please describe, based on other research, how often parents use prepared foods compared to home-cooked meals. How many children eat jarred versus store-bought ready-made meals - both in Germany and in other European countries. It is also worth referring to the amount of complementary food consumed in this youngest group and the fact that children do not eat everything their parents offer them. 

Thank you for this comment. In fact, it is important to present data on the consumption of CCF in Germany and Europe to understand the relevance of the paper’s topic. That is why we presented such data in the introduction (5^th paragraph). We cite both, a German and a pan-European study.

Conclusions

In line 43, please describe in more detail the claims made by Hutchinson et al. In your conclusions, please emphasise which inappropriate ingredients were found in the foods tested, whether more were compliant or non-compliant.

Thank you for this suggestion.

We expanded the presentation of the claims by Hutchinson as following:

“Therefore, there is a concern that such sweet CCF may contribute to sweet taste preference development and thus leading to excess energy intake [31]. This is particularly relevant against the background of a high prevalence of overweight and obesity even among preschool children (girls: 10.8 %, boys: 7.3 %) [42]. Hence, closing regulatory gaps to reduce sugar content in CCF is requested [31].”

Furthermore, we now added the following sentence in the conclusion:

“Our market survey showed that sugar content was high in most product categories, even though manufacturers avoided adding sugar and other ingredients.”

Reviewer 2 Report

Dear authors,

This manuscript reports the current commercial complementary food (CCF) in Germany. The study results could remind the parents for potential unhealthy dietary contents for infant and toddlers. Overall, this topic is important to improve childhood health outcomes. However, some minor part that should be revised and I suggested to add some references to compared the home-made CF and CCF and also the benefits of CCF in low-income area.

I have some comments and suggestions for the authors and hope that my comments are constructive to the authors.

Introduction

Line 100-108. Please move this paragraph to the method part. The introduction should focus on the purpose and knowledge gap for you to perform this study.

Discussion

1. For the clinical implication of this study, since the CCF might be unhealthy with high sugar content, which may increase the prevalence of obese or overweight in childhood. Is there any long-term follow-up data or reference for the current obese prevalence in German children? Please consider to add some information for the epidemiology data.

2. Home made infant food might be healthy for the low sugar content. Please add some information for the nutritional comparisons between CCF and home made infant food to make it clearer for readers to compare which one is healthier and better.

3. For the advantage of fortified CCF in low-income countries, fortified complementary food may provide more nutrients to prevent anemia. (Lancet Child Adolesc Health. 2022 Aug;6(8):533-544.) It is suggested that the authors could propose the potential benefits of CCF for children. Also you could add the comparisons of CCF in high versus low-income countries. (Curr Dev Nutr. 2022 May 5;6(6):nzac092.)

Author Response

Reviewer 2

Dear authors,

This manuscript reports the current commercial complementary food (CCF) in Germany. The study results could remind the parents for potential unhealthy dietary contents for infant and toddlers. Overall, this topic is important to improve childhood health outcomes. However, some minor part that should be revised and I suggested to add some references to compared the home-made CF and CCF and also the benefits of CCF in low-income area.

I have some comments and suggestions for the authors and hope that my comments are constructive to the authors.

Thank you for reviewing the paper and the positive comment.

Introduction

Line 100-108. Please move this paragraph to the method part. The introduction should focus on the purpose and knowledge gap for you to perform this study.

Thank you for this comment. We agree, that the introduction should focus on the purpose and knowledge gap. However, from this outline come the aims for the present study, which in my experience are presented at the end of the Introduction.

Discussion

1. For the clinical implication of this study, since the CCF might be unhealthy with high sugar content, which may increase the prevalence of obese or overweight in childhood. Is there any long-term follow-up data or reference for the current obese prevalence in German children? Please consider to add some information for the epidemiology data.

Thank you for this valuable comment. We have added a sentence on the prevalence of overweight and adiposity among preschool children from a recent representative study in Germany in the discussion, as the prevalence among toddlers is not known.

“This is particularly relevant against the background of a high prevalence of overweight and obesity even among preschool children (girls: 10.8 %, boys: 7.3 %) [42].”

2. Home made infant food might be healthy for the low sugar content. Please add some information for the nutritional comparisons between CCF and home made infant food to make it clearer for readers to compare which one is healthier and better.

As suggested, we added the following sentence in the limitations section: “In addition, data on home-made complementary foods are lacking, so it is not possible to assess whether they are actually healthier. Older studies from Spain and Germany concluded that the differences in composition are not large [50,51], but the variety of vegetables is lower in CCF [18].“

3. For the advantage of fortified CCF in low-income countries, fortified complementary food may provide more nutrients to prevent anemia. (Lancet Child Adolesc Health. 2022 Aug;6(8):533-544.) It is suggested that the authors could propose the potential benefits of CCF for children. Also you could add the comparisons of CCF in high versus low-income countries. (Curr Dev Nutr. 2022 May 5;6(6):nzac092.)

We have gladly accepted your important suggestion and added the following sentence to the manuscript.

“In the end, we must emphasize that our results and discussion apply only to children from affluent countries. In low-income countries, poor complementary feeding is a risk factor for malnutrition and may cause morbidity and mortality [52] and fortified complementary food may help to prevent nutrient deficiencies [53].”