P4.060: Lactose-Reduced and Hypoallergenic Infant Formulas use More Health-Related Claims about Adverse Outcomes in Marketing Language

Background: Marketing of infant formula in the United States (US) is pervasive, including extensive use of ingredient and health-based claims. These claims can significantly influence parental decisions. Hypoallergenic formulas are over-consumed in the US, compared to the prevalence of medical necessity. Similarly, 59% of powdered infant formula purchased in the US is lactose-reduced, despite lactose being the caloric carbohydrate in human milk. It remains unclear if marketing messaging influences the overconsumption of these formulas. Thus, our objective was to determine if more health or ingredient-based claims are used on hypoallergenic and lactose-reduced infant formulas in the US.

Methods: The number of health and/or ingredient-related claims on 1) infant formula packaging, 2) brand public websites, and 3) healthcare practitioner websites were documented and quantified for 76 US powdered non-exempt infant formula products on the market in 2022. All claims were classified as ingredient and/or health-related claims using previously published metrics. Health-related claims were sub-categorized as relating to either: healthy digestive processes, healthy non-digestive processes, or targeting adverse outcomes. The macronutrient composition of each formula was categorized based on the ingredients and information obtained from the manufacturer. “Standard” infant formula was defined as dairy-based, non-hypoallergenic, and non-thickened formulas.

Results: On average 4.08±1.76 ingredient-based and 4.47±1.81 health-based claims were used per product. There was no significant difference in the total number of ingredient- or health-based claims used to market hypoallergenic vs non-hypoallergenic formulas. However, hypoallergenic formula products used, on average, 1.27 more claims about targeting adverse outcomes (p = 0.006) and 1.08 fewer claims about healthy non-digestive processes (p < 0.0001).
Lactose-reduced formula used both more total ingredient-based (0.85 more claims, p=0.03) and health-based claims (0.84 more claims, p< 0.04). Lactose-reduced formulas used, on average, 0.96 more claims about targeting adverse outcomes than lactose-based formulas (p < 0.0001).
Similarly, lactose-reduced “standard” formulas also used, on average, 0.68 more ingredient-based health claims (p < 0.04) and 0.61 more health-related claims about targeting adverse outcomes compared to 100% lactose-based “standard” formulas (p ≤ 0.0001).

Conclusion: US lactose-reduced formula uses more total ingredient-based and health-based claims to market formula compared to 100% lactose formulas. Hypoallergenic and lactose-reduced formulas use more marketing claims related to reducing adverse outcomes in infants. Further research is necessary to determine whether the greater number of claims used contributes to the over-use of these products.